Deck 9: Individual Variations in Drug Response

Question 1

The nurse is providing education about warfarin (Coumadin) to a patient of Asian ancestry. The nurse determines that learning has occurred when the client makes which statement?

A) "I may need to have more frequent blood tests."
B) "I may need to have less frequent blood tests."
C) "I may need more medication than someone from a different ethnic group."
D) "I may need less medication than someone from a different ethnic group."

Answer 1

"I may need less medication than someone from a different ethnic group."

Question 2

An American Indian client has been admitted to the hospital for chemotherapy. At any given time, five family members are in the client's room. 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 called the healthcare provider and obtained an order for additional family members to be present.
C) This was the correct action; the nurse was following protocol by informing the client about hospital policy.
D) The nurse should have allowed the client to have as many family members as she wanted to be present.

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 caring for several clients. Which clients have a psychosocial history that may affect their outcome? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) Older adult who recently suffered a stroke, has an unsteady gait, and lives in a two-story home
B) Middle-aged client with Down syndrome living in a group home
C) Recently divorced mother of three children with breast cancer
D) Sixteen-year-old requesting birth control without parental consent
E) Seven-year-old with asthma in a foster care home

Answer 3

Older adult who recently suffered a stroke, has an unsteady gait, and lives in a two-story home
Middle-aged client with Down syndrome living in a group home
Recently divorced mother of three children with breast cancer

Question 4

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

Question 5

A Hispanic man has been diagnosed with attention-deficit/hyperactivity disorder (ADHD), and is taking methylphenidate (Ritalin). Even though the drug helps with focus and grades, the client 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 has developed alternative coping mechanisms to increase his focus during classes.
B) The adolescent is fearful that this drug may be a "gateway drug" and he will abuse other substances.
C) The adolescent really does not need an additional dose of methylphenidate (Ritalin) at school.
D) The adolescent is embarrassed about having to take medicine at school; it is a social stigma.

Question 6

The nurse is doing a holistic assessment on a client prior to starting antihypertensive medication. What should the nurse include in the assessment? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) Blood pressure
B) The biologic cause of the hypertension
C) Mood
D) Level of education
E) Belief in a higher power

Question 7

The nurse is conducting a holistic assessment of a client with alcoholism. What are the important questions the nurse would ask? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

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

Question 8

A nurse is teaching a community group about holistic medicine. Which information should the nurse include about Western medicine? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) Western medicine focuses on the cause of disease.
B) Western medicine is not compatible with holistic medicine.
C) The client is at the center of concern in Western medicine.
D) Disease is often viewed as a malfunction in a specific body system.
E) Western medicine may focus on disease treatment.

Question 9

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) "Do I have to inform your healthcare provider about your noncompliance?"
B) "Why didn't you take your medicine as we talked about?"
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 10

The client is admitted to the hospital with sepsis following an elective abortion. The healthcare provider orders antibiotics that the client refuses stating, "I don't deserve them." What is the best response by the nurse?

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

Question 11

The African American client has panic attacks, is suicidal, and is on an inclient psychiatric unit. The healthcare professional prescribes sertraline (Zoloft) and clonazepam (Klonopin). The client refuses the drugs. The client also 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 without seeking further information from the client.
B) Allow the request as long as the herbs and objects do not pose a safety risk for the client or other clients.
C) Allow the request after the client signs a release of responsibility to avoid litigation.
D) Allow the request after all members of the treatment team agree to it.

Question 12

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

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

Question 13

A nursing instructor is teaching a nursing student about human DNA sequences. The student demonstrates understanding by making which of the following statements?

A) "Only 2% of human DNA is different among the different ethnicities."
B) "Due to enzyme polymorphism, Hispanics are less likely to metabolize codeine to morphine."
C) "Even though human genetic differences are small, significant differences can be seen with drug metabolism."
D) "Asian Americans are the ethnic group known to be slow acetylators."

Question 14

The nurse manager would determine that a nurse understands culturally sensitive care if which statements are made? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) "Since all of our clients have the same illnesses, I sometimes get bored."
B) "I have been helping my client understand how to choose foods from our diet menu."
C) "I am concerned because my client needs sterile dressing changes but has no running water at home."
D) "My client and I worked out a way to get her medications delivered to her at home."
E) "I invited a group from my church to come and sing hymns for our clients."

Question 15

The African American client had a myocardial infarction and is receiving atorvastatin (Lipitor). 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) Ask an African American nurse to speak to him about a low-fat diet.
B) Discuss his diet with whomever prepares meals for his family.
C) Give the client information specific to African Americans about low-fat diets.
D) Obtain a consult for dietary services so a dietician can teach the client about low-fat diets.

Question 16

A nurse is teaching a group of student nurses. Which of the following best indicates an ethnic characteristic that can affect pharmacotherapy?

A) Genetic differences
B) Diet
C) Health beliefs
D) Alternative therapies

Question 17

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

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

Question 18

A nursing student asks a nurse how gender influences pharmacology. How should the nurse respond?

A) Women tend to seek medical care earlier than men do.
B) Heart disease has traditionally been thought of as a woman's disease.
C) Since the 1980s, the FDA has mandated that research studies include both male and female subjects.
D) Studies indicate that men and women suffer from Alzheimer's disease in equal numbers.

Question 19

A client is diagnosed with cancer. The healthcare provider 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." With permission from the client, what would the nurse do first?

A) Involve a hospital minister to discuss the client's perspective about cancer.
B) Plan to bring the case before the hospital's board of ethics.
C) Contact the client's minister to discuss the client's perspective about cancer.
D) Meet with family members to discuss the client's perspective about cancer.

Question 20

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

Question 21

A client is a vegan vegetarian and does not eat any animal products. The healthcare provider has prescribed a medication contained in a gelatin capsule. The nurse understands that a gelatin capsule is made from animal products. Which nursing actions are indicated? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) Do not tell the client the capsule contains gelatin.
B) Collaborate with the prescriber to find an alternative medication.
C) Check to see if the capsule can be opened for administration.
D) Work to convince the client that this application does not violate vegetarian beliefs.
E) Tell the client that the gelatin is an inactive ingredient in the medication.

Question 22

The nurse in charge of a clinical study welcomes the participants in an open forum. One client is surprised that there are men and women from several ethnic groups. The nurse explains that in the past, ethnic variables were largely unknown or ignored for what reasons? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) Clinical trials failed to include ethnically diverse subjects.
B) Clinical trials comprised mostly Caucasian males.
C) Little attention was focused on identifying the different effects drugs had on various ethnic groups.
D) Research proved there were no differences among ethnic groups.
E) The large majority of clinical trials included Caucasian females.

Question 23

A client's genetic testing reveals a change in CYP2A6. The nurse would plan which interventions based on this discovery? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) Teaching the client to avoid caffeine-containing drugs.
B) Planning additional time and interventions to help the client stop smoking.
C) Use of an alternative to the drug warfarin.
D) Increased surveillance for the development of lung cancer.
E) Frequent monitoring of blood pressure.

Question 24

A nurse administering medications to a variety of patients on a medical-surgical floor recognizes which of the following clients may need additional education about medication adherence? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) Fifty-year-old recently remarried male taking antihypertensive medication
B) Thirty-four-year-old female with family history of blood clots taking an estrogen oral contraceptive
C) Thirty-eight-year-old male recently started on an antidepressant
D) Twenty-eight-year-old female started on acne medication known to cause male-patterned hair growth
E) Seventy-eight-year-old female being treated for shingles

Question 25

Which patient statements would the nurse evaluate as negatively affecting access to healthcare? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) An older adult says, "If I tell my doctor that I fall frequently, I might have to go to a nursing home."
B) A young adult says, "A benefit of my new job is that it pays for my health, dental, and vision insurance."
C) A client being discharged says, "Can you call my prescriptions in to the pharmacy?"
D) The client's new insurance plan requires a $10 copay for office visits.
E) A client asks to be discharged before noon as he has a 3-hour drive home.

Question 26

The nurse in the emergency department is caring for several clients from diverse cultures. Which statement shows the nurse's ability to provide culturally competent care? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) "I understand your religion prohibits blood transfusions. Would you consider nonblood alternatives?"
B) "I just want to make sure you and your spouse understand the risks as you consider the options."
C) "I don't really understand why you are afraid to take the medication. Do you have any questions I can answer to alleviate your fear?"
D) "I really don't understand why you won't consider an abortion. Your admission papers say you are an atheist."
E) "I'm not quite sure why the healthcare provider is giving you these prescriptions. You didn't get them filled the last time you were here."

Question 27

A nurse has been asked to present health promotion information at a community clinic whose clients are primarily non-Hispanic Black women. After review of health disparity and inequality statistics the nurse chooses to include information about which disorders? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) Stroke
B) Coronary artery disease
C) Diabetes
D) Illicit drug use
E) Prenatal care

Question 28

A home health nurse's patient caseload is ethnically diverse. Which interventions show understanding of cultural variables? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) Discussing cultural preferences for herbs and spices and possible alternatives when drug interactions are possible
B) Assessing the client's response to acupuncture for pain
C) Discussing the client's beliefs regarding treatment
D) Notifying the healthcare provider of the client's intentions to consult with a medicine man for spiritual guidance
E) Removing the client's collection of herbs to decrease the risk of an adverse effect when taken with Western medicine

Question 29

A client asks the nurse why a medication prescribed by the provider "didn't do anything at all." Which statement by the nurse accurately describes how genetics influence drug action? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) "Genetic differences can result in significant differences in how each client's body handles the same medication."
B) "Genetic differences can cause mutations in enzymes, changing the way they function. This can alter how the body metabolizes and excretes drugs."
C) "Because of genetic differences, medication may accumulate to toxic levels in one client while in another client may be inactivated before it can have a therapeutic effect."
D) "Genetic differences can be expressed as an alteration in the structure of an enzyme, which can cause a defective receptor and an allergic response to drugs."
E) "Genetic differences in clients who are biracial result in an allergic response to medications."

Question 30

A client's genetic testing indicates the presence of a genetic polymorphism of the CYP 450 enzyme. The nurse expects this difference to be one of which classifications? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

A) Extensive
B) Poor
C) Normal
D) Ultrarapid
E) Inefficient