Deck 3: Professional, Personal and Cultural Influences on Pharmacology

Question 1

A client develops angioedema and difficulty swallowing after receiving an intravenous medication. What effect is this characteristic of?
1) A minor adverse effect
2) A life-threatening adverse effect
3) An unpredictable side effect
4) A reaction secondary to urticaria

Answer 1

2

Question 2

The nurse is conducting a holistic assessment of a client diagnosed with alcoholism. Which priority questions should the nurse include in the assessment? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1) "Did you see your parents drink alcohol when you were growing up?"
2) "How old were you when you started drinking?"
3) "Have you ever attended Alcoholic Anonymous meetings?"
4) "Have you been treated with medications designed to discourage consumption of alcohol?"
5) "Have any of your blood relatives been addicted to alcohol?"

Answer 2

1,2,3,5

Question 3

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.
Standard Text: Select all that apply.
1) ".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."
2) "Genetic differences can cause mutations in enzymes, changing the way they function. This can alter how the body metabolizes and excretes drugs."
3) "Because of genetic differences, medication may accumulate to toxic levels in one client while in another client may be inactivated before it can have a therapeutic effect."
4) "Genetic is responsible for significant differences in how each client's body handles the same medication"
5) "Genetic differences in clients who are biracial result in an allergic response to medications."

Answer 3

2,3,4

Question 4

A health care provider recommends chemotherapy for a client diagnosed with cancer. The client tells the nurse, "This is a punishment from God for the sins I have committed. Some of the women at my church say so." Which intervention will best meet the client's spiritual needs?
1) Plan to involve a hospital minister to discuss the client's perspective about cancer.
2) Ask to meet with family members to discuss their feelings the client's prognosis.
3) Ask the client if she would like a visit from her minister.
4) Ask the client if she would like to meet with other individuals who are experiencing chemo.

Question 5

An adult client of middle eastern-Jewish decent is prescribed hydrazine to treat his high blood pressure. Why would the nurse question this prescribed medication order?
1) The client has a history of side effects to other antihypertensive medications.
2) The client may exhibit slow acetylation.
3) The client has a history of poor renal function.
4) The client may not metabolize the medication due to CYP2D6.

Question 6

A home health nurse's client caseload is ethnically diverse. Which interventions show understanding of cultural variables? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1) Assessing the client's response to acupuncture for pain.
2) Discussing the client's beliefs regarding treatment.
3) Notifying the health care provider of the client's intentions to consult with a medicine man for spiritual guidance.
4) Removing the client's collection of herbs to decrease the risk of an adverse effect when taken with Western medicine.
5) Discussing cultural preferences for herbals and possible alternatives when drug interactions are possible.

Question 7

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?
1) Inform the husband that he must sign a release of responsibility to avoid future litigation against the hospital.
2) Allow this request, and be available in the event the request changes.
3) Inform the husband that it is his wife's choice whether to receive analgesia.
4) Allow the request, but inform the husband that the primary health care provider will make the final decision regarding analgesia.

Question 8

Which of the following client assessment reveals a psychosocial history that may affect the client's outcome? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1) Older first nation adult who has had a stroke that lives in a remote northern community.
2) Middle-aged client with alcoholism living on the street.
3)Seven-year-old with asthma in a foster care home
4) Sixteen-year-old requesting birth control without parental consent
5) Recently divorced mother of three children with breast cancer

Question 9

The nurse is caring for an Asian American client diagnosed with terminal cancer. Which factor should the nurse consider to achieve adequate pain control for the client?
1) All ethnic groups respond to medications in the same manner.
2) The only variation in drug metabolism occurs among African Americans.
3) Asians respond differently to antiemetics only.
4) Opioids are metabolized differently in individuals of Asian descent.

Question 10

A Caucasian nurse is caring for an African American client who has a history of myocardial infarction and is receiving atorvastatin (Lipitor). The nurse assesses the client's diet to be very high in fat. Which teaching plan would be most effective at improving the client's diet and possibly reducing the need for additional medications?
1) Plan to ask an African American nurse to speak to the client about low-fat diets.
2) Discuss the client's diet with whoever prepares meals for the family.
3) Give the client a printout about low-fat diets specific to African Americans.
4) Ask the health care provider for a consult by dietary services so a dietician can teach the client about low-fat diets.

Question 11

The primary health care provider has prescribed isoniazid (INH) for a client of Japanese descent diagnosed with tuberculosis. What factor must be considered in regard to the therapeutic effectiveness of this drug?
1) People of Japanese descent are known as rapid acetylators.
2) People of Japanese descent are usually allergic to isoniazid.
3) People of Japanese descent may not take this medication to treat their tuberculosis.
4) People of Japanese descent are known as slow acetylators.

Question 12

The nurse in charge of a clinical study welcomes the participants in an open forum.There are members from diverse ethnic groups represented. Which of the following are the reasons why in the past ethnic variables were largely unknown or ignored for which reasons? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1)Clinical trials failed to include ethnically diverse subjects.
2) Little attention was focused on identifying the effects drugs had on various ethnic groups.
3) Research proved there were no differences among ethnic groups.
4) The large majority of clinical trials included Caucasian females.
5)Clinical trials comprised mostly Caucasian males.

Question 13

The student nurse has just finished a class on the concept of holistic pharmacology. Which statement by the student indicates the need for clarification on the concept.
1) The human integration pyramid is used to address nursing and pharmacological needs of client.
2) All levels of the pyramid provide specific guidance related to certain drug classes and nursing actions.
3) This approach helps to better understand how risk factors such as age and genetics influence pharmacotherapeutics.
4) The whole client is often lost in western medicines approach to treating disease.

Question 14

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?
1) Plan to assess the client for any cultural concerns about the medication.
2) Plan to teach the client the importance of taking his medication.
3) Plan to assess the client for sexual side effects such as erection difficulty.
4) Plan to design a teaching plan about medication that includes the client's wife.

Question 15

The nurse is providing education about warfarin (Coumadin) to a group of Asian American and African American clients who have experienced strokes. The nurse determines that learning has occurred when the clients make which statement?
1) "We might need to have more frequent blood tests."
2) "We might need less medication than other ethnic groups."
3) "We might need to have less frequent blood tests."
4) "We might need more medication than other ethnic groups."

Question 16

An adolescent male with attention deficit hyperactivity disorder (ADHD) is taking methylphenidate (Ritalin). The adolescent will not go to the school nurse at noon for his medication. Which does the nurse learn from her assessment?
1) The adolescent really does not need an additional dose of methylphenidate (Ritalin) at school.
2) The adolescent is embarrassed about having to take medicine at school; it is a social stigma.
3) The adolescent is fearful that this drug might be a "gateway drug" and he will abuse other substances.
4) The adolescent has developed alternative coping mechanisms to increase his focus during classes.

Question 17

The nurse is performing a holistic assessment on a client prior to administering antihypertensive medication. Which factors would be included in the holistic assessment? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1) Blood pressure
2) Belief in a higher power
3) Level of education
4) The symptoms of the hypertension only
5) Mood

Question 18

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? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1) "Can you tell me why you are afraid to take the medication. Do you have any questions I can answer to alleviate your fear?"
2) "I really don't understand why you won't consider an abortion. Your admission papers say you are an atheist."
3) "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."
4) "I understand your religion prohibits blood transfusions. Would you consider non-blood alternatives?"
5) "I just want to make sure you and your spouse understand all risks as you consider the options."

Question 19

A First Nations client is in hospital for treatment of colon cancer. He has a large family that visit often. The nurse overhears the client tell his brother that all the family will be there for the beginning of his chemotherapy treatment. What is the best action of the nurse at this time?
1) Tell the client that it is against hospital regulations to have more than two visitors at a time.
2) Move the client to a private room and negotiate with him as to the number of visitors he can have at one time.
3) Explain to the client that fire regulations in the hospital will not allow him to have that many visitors.
4) Document that the client's preference about the number of family members present was not completed on admission.

Question 20

The nurse is teaching a mixed-gender class how to prevent heart attacks. What important factor related to gender will the nurse include in the teaching plan?
1) Heart disease affects men and women equally.
2) All medications used to prevent heart attacks affect men and women the same.
3) Medications such as aspirin, are more effective in preventing heart attacks in women than in men.
4) Medications such as aspirin, are more effective in preventing heart attacks in men than in women.

Question 21

The nurse determines that an idiosyncratic reaction to a drug has occurred when the client experiences drug effects that have which characteristic?
1) Predictable
2) Unexplained
3) Irreversible
4) Life threatening

Question 22

Which food on a client's tray could cause a drug-food interaction with warfarin (Coumadin)?
1) Banana
2) Toasted cheese sandwich
3) Iced tea
4) Spinach salad

Question 23

Nursing student have completed their class on drug interactions. What statement by a student indicates understanding of the content taught?
1) "Drug-drug interactions are more serious than drug-food interactions."
2) "All drugs will have some type of interaction."
3) "Drug interactions should always be avoided."
4) "Some drug interactions can produce therapeutic effects."

Question 24

The nurse plans to monitor a client for dermatologic toxicities after administering which medication?
1) Salicylates
2) Antiseizure drugs
3) Antithyroid drugs
4) Loop diuretic

Question 25

The nurse is conducting medication teaching for a client recently prescribed a calcium channel blocker. Which food will the nurse caution the client to avoid when taking this medication?
1) Grapefruit and grapefruit juice
2) Coffee
3) Dairy products
4) Green, leafy vegetables

Question 26

A nurse is caring for a client diagnosed with acute asthma who is taking several medications. The nurse would suspect a common adverse drug effect when the client exhibits which symptoms? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1) Headache
2) Nausea
3) Vomiting
4) Changes in blood pressure
5) Loss of hearing

Question 27

A client has been on a statin drug for treatment of hyperlipidemia for 6 months. He is admitted to the hospital with right upper quadrant pain, nausea, and fatigue.Which of the following laboratory results would the nurse expect abnormal results?
1) Elevated liver function tests
2) Elevated creatinine levels
3) Decreased blood sugar
4) Decreased prothrombin time

Question 28

The nurse monitors a client with a blood pressure of 86/56. She is aware that he was just started on a newly prescribed antihypertensive drug. What type of reaction is the client experiencing?
1) An allergic response to the drug
2) A therapeutic drug effect
3) An adverse drug effect
4) An idiosyncratic drug reaction

Question 29

The nurse explains to a student nurse that side effects differ from adverse events in which way?
1) Adverse effects cause permanent damage.
2) Side effects are usually more serious than adverse effects.
3) Side effects are predictable at therapeutic levels.
4) Adverse effects are usually dose-related.

Question 30

What information about a new medication, should the nurse include in her teaching plan? Note: Credit will be given only is all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1) Adverse effects that can be expected
2) Which adverse effect to report to the health care provider
3) The drug's therapeutic action
4) Chemical composition of the drug
5) Name of the drug manufacturer

Question 31

A 70 year old client has been self treating joint pain with maximum daily doses of an NSAID for 3 weeks. Which of the following would the nurse expect to find in her assessment?
1) Decreased renal function
2) Difficulty hearing
3) Decreased liver function test
4) Orthostatic hypotension

Question 32

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

Question 33

A client with a documented allergy to penicillin is prescribed cephalosporin. The nurse will monitor the client for allergic responses, since cephalosporin can cause which reaction?
1) A heightened drug reaction
2) Pseudo-allergy
3) Cross-allergy
4) A hyporesponsive reaction

Question 34

A client with a history of multiple allergies is prescribed a new anti-infective. At which time should the nurse plan to monitor the client for an anaphylactic reaction?
1) Within 24 hours of receiving the first dose
2) Immediately after receiving the first dose
3) At any time while receiving the drug
4) Within one hour of receiving the first dose

Question 35

A client is prescribed tetracycline for an infection. The nurse instructs the client to avoid which food to prevent a possible drug-to-food interaction?
1) Citrus juices
2) Dairy products
3) Legumes
4) Beef

Question 36

A pregnant client is prescribed a medication and is concerned it might have teratogenic effects. Which response by the nurse is the most appropriate?
1) "Let me check the pregnancy risk category of the drug."
2) "Are you in your first trimester of pregnancy?"
3) "If your health care provider ordered the medication, it should be okay."
4) "You should avoid taking any medications while pregnant."

Question 37

Which clinical manifestation would the nurse identify as an allergic reaction?
1) Urticaria
2) Photosensitivity
3) Abdominal cramping
4) Complaints of diarrhea

Question 38

A client is receiving an antiviral drug that is a substrate of the CYP3A4 enzyme system. A drug that is an inhibitor of the 3A4 system is added to the client's regimen. What result will the nurse assess the client for?
1) Toxicity of the antiviral drug
2) No change in viral-related symptoms
3) A decrease in the antiviral drug side effects
4) An increase in viral load

Question 39

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? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1) Medical history
2) Current lab results
3) Number of previous hospitalizations
4) Use of dietary supplements
5) Side effects of all medications the client is taking

Question 40

A client is scheduled to receive a diuretic and a beta blocker. The nurse determines the combination of these drugs will have which effect on the client's blood pressure?
1) Oppositional
2) Synergistic
3) Antagonistic
4) Additive

Question 41

A nurse in the emergency department is preparing to care for a client suspected of an opiate overdose. The nurse is preparing to give the client a medication called naloxone (Narcan). Which rationales support the use of this medication? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1) It reverses the effects of the overdose.
2) It is an antagonist.
3) It has an additive effect.
4) It has a synergist effect.
5) It causes CNS depression.

Question 42

A nurse is planning care for a client taking a medication with the potential to cause bone marrow toxicity. Which interventions exemplify the nurse's role in preventing complications? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1) Assess the client for signs and symptoms of infection.
2) Assess the client for signs and symptoms of anemia.
3) Monitor the client for signs and symptoms of fatigue.
4) Monitor the client for evidence of bruising.
5) Monitor the client for insomnia.

Question 43

A nurse is caring for a client recently prescribed an oral antibiotic who is exhibiting signs of dermatologic toxicity. Which assessment findings support dermatologic toxicity? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1) Rash
2) Itching
3) Urticaria
4) Sunburn
5) Photosensitivity

Question 44

A nurse is caring for a client who is exhibiting signs of an adverse reaction to warfarin (Coumadin). Which statements made by the client would lead the nurse to suspect that this is the case? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1) "I'm from the South, and we have buttermilk almost every meal."
2) "I was suffering so much from hot flashes until my friend told me to try an herb called St. John's wort. I don't seem to have as many symptoms as before."
3) "My husband makes me put garlic in everything! He heard it helps keep our blood pressure normal."
4) "I heard ginkgo was really good for improving memory so I started taking it a couple of months ago."
5) "I was having difficulty sleeping a couple months ago, and my neighbor recommended I try kava. It seems to calm my nerves."

Question 45

The nurse is caring for a client who is taking a drug known to cause nephrotoxicity. Which interventions are appropriate to prevent drug-induced nephrotoxicity? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1) Providing proper nutrition
2) Monitoring diagnostic lab tests for changes in kidney function
3) Identifying drugs that affect kidneys and discuss adjusting doses
4) Determining whether the client has kidney impairment
5) Encouraging hydration

Question 46

The student nurses have completed their first class on drug administration and the roles and responsibilities of the nurse. Which statement by one of the students indicate that more clarification is required Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1)"It is important for us to know why a physician would order a particular type of antibiotic."
2) "We need to use our knowledge of pathophysiology and how it may impact the median effective dose of the drug."
3) "A nurse needs to understand that a common serious side effect of narcotics is respiratory depression."
4) "We need to know how a pain medication blocks pain receptors in the body."
5) "How altered protein levels in the body will affect the metabolism of the drug."

Question 47

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? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1) A second drug from the same class is added to prevent the dose of the first drug from being increased.
2) Adding a second drug may allow both drugs to be used at a lower dose.
3) The effect of two drugs from different classes may have a greater effect than two drugs from the same class.
4) Adding the second drug will result in an antagonist effect and result in an increase the effects.
5) Adding a second drug rather than increasing the dose of the first may decrease incidence of adverse effects.

Question 48

A nurse is sharing her knowledge of drug allergies with a student who is caring for a client who has a suspected allergy to a new medication she is taking. What statements by the student indicates an understanding of the information. Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1) "Signs and symptoms of drug allergy range from minor to life threatening."
2) "Drug allergy symptoms may appear the same as common allergies to other substances, such as environmental triggers."
3) "It is important to determine the source of the allergy."
4) "Nausea and vomiting are the most common drug allergy symptoms."
5) "Drug allergies require previous exposure."

Question 49

The nurse is caring for a client who is prescribed laxatives. Which of the following statements indicate how absorption of medications is affected by the laxative? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1) Drugs that increase peristalsis may decrease absorption.
2) Drugs that decrease peristalsis may increase absorption.
3) The presence of food will usually decrease absorption.
4) Drug-drug interactions that affect absorption may be prevented by taking the drugs 2 hours apart.
5) Increasing fluid intake will increase absorption.

Question 50

Which of the following signs and symptoms would be indicative of neurotoxicity in a client taking a medication known to cross the blood-brain barrier? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1) Visual changes
2) Loss of balance
3) Loss of hearing
4) Depression
5) Nausea and vomiting

Question 51

The nurse would anticipate an alteration in drug absorption in clients with which conditions? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1) Vomiting
2) Diabetes
3) Diarrhea
4) Asthma
5) Alzheimer disease

Question 52

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? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1) "There are some medications I cannot take because I am pregnant and they could hurt my baby."
2) "I need to check with my doctor before I take any medication because some drugs can hurt my baby."
3) "I should consider all drugs to be harmful to my baby unless my doctor tells me it is okay."
4) "I have to be very careful to let all my health providers know that I am pregnant before they prescribe medications for me."
5) "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."

Question 53

The nurse is planning care for a client newly diagnosed with emphysema who complains that the medication is causing a "shaky" feeling. What does the nurse recognize this as? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1) A predictable side effect of the medication
2) An annoying side effect of the medication
3) A dose-dependent side effect of the medication
4) An allergic response to the medication
5) A serious adverse effect of the medication

Question 54

Mrs Annan is recovering from hip replacement surgery and has asked the nurse for pain medication. The student reads the order as" Give 1-2 mg of Dilaudid subcutaneously q 3-4 h prn." and verifies the order on the MAR. After completing her research on the drug, she administers Dilaudid 1 mg. What is the student required to document?
1) The time and her signature
2) The dose, site and her signature
3) The time, dose, the site and her signature
4) The drug, range of dose, time and her signature

Question 55

The nurse would anticipate an alteration in drug excretion in clients with which conditions? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1) Kidney disease
2) Heart disease
3) Diarrhea
4) Asthma
5) Alzheimer disease

Question 56

A client is prescribed tetracycline for acne. Which foods should the nurse ask the client to avoid while taking this medication? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1) Milk
2) Almonds
3) Ice cream
4) Fish
5) Grapefruit juice

Question 57

A nurse is reinforcing discharge instructions concerning food-drug interactions. Which statements by the client indicate correct understanding of the discharge instructions? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1) "I should take my medications with water to avoid any problems with my medications being absorbed."
2) "I cannot take one of my medications with grapefruit juice because it will decrease the absorption of the medication."
3) "I need to be sure to read the prescription label because the pharmacist will indicate if I need to take my medication with food or without food."
4) "I should take my daily vitamin 2 hours after my medication so they do not affect each other."
5) "If I take my medication with hot tea, it will not affect absorption."

Question 58

MCSA The nursing process is an integral part of drug administration. Where do the 10 rights of drug administration fit within this process?
1) Assessment
2) Diagnosis
3) Planning
4) Evaluation

Question 59

A nurse educator explaining drug allergies to students includes which statements in the teaching? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1) "Drug allergies occur with very small amounts of drug."
2) "The symptoms of drug allergies are unrelated to the pharmacologic actions of the drug."
3) "Drug allergies require a previous exposure to the drug."
4) "The symptoms of a drug allergy are produced by an underactive response by the body's defences."
5) "The severity of the allergic response is directly related to the dose of the drug."

Question 60

An instructor and student are checking the physician's order for a new medication for the client. The order reads; " Give 1 cap tid ac with water." How does the student interpret this order?
1) Give 1 capsule twice daily before meals with water.
2) Give 1 capsule three times daily after meals with water.
3) Give 1 capsule twice daily after meals with water.
4) Give 1 capsule three times daily before meals with water.

Question 61

The nurse is preparing to give pain medication to a client. the physician has left specific orders that it can be given in a number of routes. Which of the following would provide the quickest onset of action for this pain medication.
1) Subcutaneously
2) Intramuscularly
3) Enterally
4) Transdermally.

Question 62

Following a class on adverse drug reactions and medication errors, the students are asked to document the causes of errors. Which of the following does a student include in her list? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1) Failure to follow health care provider's orders
2) Failure to assess for allergies.
3) Failure to give a medication at the ordered time
4) Failure to clarify orders with the pharmacy
5) Failure to give the right dose of the medication

Question 63

MCMA A student nurse is preparing to administer a nitroglycerin transdermal patch on her client for his heart disease. Before she goes into the room, her instructor asks her to walk through the steps she will take to administer this drug. What does the student include in her answer?
Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1) Wear gloves during administration
2) Ask client where they would prefer to have patch applied
3) Remove old patch
4) Document date, dose and initials on the patch
5) Document date, time and initials on the MAR

Question 64

MCSA A nurse was involved in a medication error a week ago that caused an adverse effect on the client. The nurse manager has asked her to participate in a multidisciplinary group looking at the circumstances around the error. The nurse states that she met her responsibility by completing the incident report. How does the nurse respond to the RN?
1) " If you do not attend, it will be reflected on your file."
2) "I will get someone to relieve you while you attend."
3) "Your union steward is welcome to attend with you."
4) " It's part of your ethical responsibilities to help prevent similar errors."

Question 65

The nurse has just received an order to add 1 ampoule of multivitamin to her client's continuous infusing IV. The client's IV bag has about 950 mls left to be absorbed. What actions by the nurse regarding this order is most appropriate?
1) Stop the IV and add the 1 ampoule of medication to the existing bag, restart the IV.
2) Ask the physician if you can give the medication orally.
3) Add the medication to a new bag and hang immediately
4) Add the medication to a new bag and hang when it is time change the bag.

Question 66

The nurse in the clinic is instructing a father on how to install ear drops to his infant son. What important information does the nurse include in her instructions?
1) Draw up the medication in accurate measuring spoon, lie the baby on his side, pull the pinna of his ear backward and slightly upward, keep on his side for about 10 minutes following.
2) Lie baby on his side, pull the pinna backward and slightly downward, apply intermittent pressure on the tragus, keep on side for 10 minutes.
3) Lie baby on side, pull pinna backward and slightly upward, apply drops from about .5cm above ear canal, keep baby on side for 10 minutes.
4) Draw up medication in dropper, lie baby on side, pull pinna of ear backward and slightly downward, apply drops from approximately 1.5 com from the canal.

Question 67

The student is preparing to administer oral medications to a client who has difficulty swallowing because of a stroke. The nurse asks the student, "Do you know what kinds of medications you should not crush?' Which Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply.
1) Antiemetic tablets
2) Enteric coated aspirin
3) Sublingual tablets
4) Antihypertensive capsules
5) Sustained release capsules

Question 68

The nurse administers an evening medication to a client in the morning. The medication did go to the correct client. What is the nurse's best course of action at this time?
1) Notify the health care provider to ask if any further action needs to be taken.
2) Notify the health care provider about the error, and complete an incident report.
3) Tell the evening nurse to hold the evening dose just for tonight.
4) Change the medication administration time to the morning.

Question 69

The nurse in the emergency department miscalculates, and administers the wrong dosage of an antibiotic to a 9-month-old baby. As a result, the baby suffers permanent brain damage. Which factor most likely contributed to the error?
1) Lack of adequate oral or written communication
2) Name confusion involving similar-sounding drugs
3) Mislabeled products
4) Human factors

Question 70

The nursing instructor teaches the students how medication errors can occur. Which common errors will the instructor discuss? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1) Failure to validate a written order with the health care provider.
2) The nurse administers the incorrect drug.
3) The nurse miscalculates the medication dose.
4) The nurse misinterprets a health care provider's order.
5) The nurse does not check the client's identification band.

Question 71

Mr Lin is being discharged home with a strict fluid restriction. The discharge order reads may have 1440 ml total fluid volume daily. How does the nurse interpret the order to Mr Lin and his family.
1) Mr Lin may have eight 8 oz glasses of fluid daily
2) He may have six-8oz glasses of fluid daily
3) He may have a total of five-10 oz glasses of fluid per day.
4) Mr Lin may have six-10 oz glasses of fluid per day.

Question 72

Which of the following drugs would undergo hepatic first pass metabolism? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1) Antihypertensive capsule
2) Nitroglycerin sublingual
3) Midazolam patch buccaly
4) Antitussive cough syrup
5) Analgesic tablet

Question 73

The student is preparing to give her first subcutaneous injection to her client. What information that she shares with her instructor about this skill indicates the need for more teaching? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1) " I will choose an area to administer avoiding bony prominences."
2) " I will choose a 3 ml syringe with a 22 -25 gauge needle for injection."
3) " I will wear gloves when cleaning the site and administering injection."
4) " I will not give more than 5 mls of medication by this route."
5) " I will gently pat the site with an antiseptic swab after injection."

Question 74

Which agency in Canada developed a program to provide health personnel with access to current health product safety information including advisories, drug recalls, and warnings?
1) Canadian Patient Safety Institute. (CPSI)
2) Canadian Adverse Drug Reaction Monitoring Program (CADRMP)
3) Institute for Safe Medication Practices Canada (ISMP)
4) Marketed Health Products Directorate (MHPD)

Question 75

Which is the correct method in administering a buccal medication?
1) Place pill under tongue, instruct client not to swallow, stay with client until pill absorbs
2) Place pill between gum and cheek, instruct patient not to swallow, offer glass of water after pill is absorbed.
3) Place pill between gum and cheek, offer client a glass of water, stay with client until it is absorbed.
4) Place pill under tongue, instruct client to swallow as necessary, stay with client until pill is absorbed.

Question 76

What is additional information can the nurse share with Mrs. Benton that will ensure accuracy of the dose delivered to her son? Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1) "You may need to give more than one spoonful depending on the size of your utensils."
2) " You should use your baking measuring spoons to give a more accurate dose."
3) "You may need to use less than 1 spoonful if your utensils are large."
4) " Ask the pharmacist to include a medication syringe with your antibiotic

Question 77

The nurse is preparing to give a subcutaneous injection to a woman who is 165 cm tall and weighs 49 kg. What is the correct method for injection.
1) Pinch skin between thumb and forefinger and inject at a 90 angle.
2) Spread skin between forefinger and thumb and inject at a 90 degree angle.
3) Pinch skin between thumb and forefinger and inject at a 45 degree angle.
4) Spread skin between thumb and forefinger and inject at a 45 degree angle.

Question 78

Health Canada, through it's medication incident reporting program uses the information reported to it on specific types and incidences of medication errors to determine contributing factors. What is a common factor involving the client or caregiver?
1) Taking medications as the practitioner has ordered
2) Never trading drugs with anyone
3) Taking drugs prescribed by more than one practitioner
4) Filling prescriptions at several pharmacies

Question 79

Who commonly collaborates with the nurse on checking the accuracy of the medication prior to administration?
1) Another nurse
2) The pharmacist
3) The health care provider
4) The nursing unit manager

Question 80

A student has just administered her first intramuscular injection. After correctly landmarking the site, she injects at a 90 degree angle, aspirates and draws up blood. What is her next action?
1) Pull the needle back about 0.5 cm and inject the medication.
2) Withdraw the needle, hold pressure on site, change needle and re-landmark.
3) Withdraw the needle, change the needle and re-landmark
4) Withdraw the needle and prepare new injection.