1. A nurse has been assigned to care for a 52-year-old attorney who has hypertension and peptic ulcer disease. Before administering his medications, the nurse must complete an initial assessment. Core patient variables will be obtained from which of the following? (Select all that apply.)
  A) The patient’s interview
  B) The patient’s medical history
  C) The patient’s medical record
  D) The patient’s physical examination
  E) The patient’s health insurer
  Ans: A, B, C, D
  Data should be obtained from sources including the patient interview, history, documentation, and examination. The patient’s health insurance provider is not a component of the initial patient assessment. Pertinent findings can be assimilated to form a current, accurate picture of the patient’s needs regarding drug therapy. Also, these facts will establish a baseline for the patient’s treatment and care.
2. A 68-year-old female patient who was diagnosed with hypertension 2 weeks ago and was prescribed a new hypertension medication has returned to the clinic for a follow-up visit. The nurse notes that the patient’s blood pressure is unchanged from her last clinic visit. When the patient was asked if she was taking the new medication on a regular basis, she stated, “I thought that I was supposed to take the new drug when I had a pounding headache or was in a stressful situation, not all the time.” An appropriate nursing diagnosis for this patient would be which of the following?
  A) Knowledge, deficient due to the lack of understanding of treatment regimen
  B) Coping, ineffective due to forgetfulness
  C) Confusion, acute concerning drug administration
  D) Anxiety due to diagnosis of hypertension
  Ans: A
  Knowledge, Deficient is usually appropriate for a patient who has a new drug prescription and is not fully aware of why he/she is taking the drug or how to appropriately take the drug. Coping, Ineffective relates to a patient who may continually forget to take a drug for a chronic condition. Anxiety could be appropriate for someone who has just been diagnosed with hypertension, but the question does not indicate that the patient is anxious.
3. In order to promote therapeutic drug effects, the nurse should always encourage patients to
  A) take their medication with meals.
  B) take their medication at the prescribed times.
  C) increase medication dosages if necessary.
  D) use alternative therapy to increase the effects of their medications.
  Ans: B
  Taking a drug at the appropriate time will help the patient maintain therapeutic drug levels. Not all medications should be taken with food, which can alter the absorption of some drugs. A patient should never increase or decrease a medication dosage without checking with the prescriber. Alternative therapy should only be used if the patient has discussed the therapy with the prescriber and they are in agreement.
4. A patient is treated with an antibiotic for an infection in his leg. After 2 days of taking the antibiotic, the patient calls the clinic and reports that he has a rash all over his body. The nurse is aware that a rash can be an adverse effect of an antibiotic and can be either a biologic, chemical, or physiologic action of the drug, which is an example of
  A) pharmacotherapeutics.
  B) pharmacokinetics.
  C) pharmacodynamics.
  D) pharmacogenetics.
  Ans: C
  Pharmacodynamics is the biologic, chemical, and physiologic actions of a particular drug within the body and the study of how those actions occur, including adverse effects. It is how the drug affects the body. The pharmacodynamics of a drug is responsible for its therapeutic effects and sometimes its adverse effects. Pharmacotherapeutics refers to the desired, therapeutic effect of the drug. Pharmacokinetics is the changes that occur to the drug while it is inside the body. Pharmacogenetics is the study of how genetic variables affect the pharmacodynamics of a drug in a specific patient.
5. A nurse has been assigned the task of preparing educational materials for patients with diabetes. The nurse has included the drug name, the reason the drug was prescribed, the intended effect of the drug, along with important adverse effects that should be reported to the nurse or the health care provider. Which of the following information is essential to include in the educational materials?
  A) Drug administration method
  B) Core drug knowledge
  C) Vital signs of the patient
  D) Diagnosis and outcome identification mechanism
  Ans: A
  In addition to all the drug details, the nurse needs to include the best method to self-administer a drug, drug–food or drug–drug interactions, any dietary restrictions, and the time and duration of the treatment. A nurse is expected to possess core drug knowledge, but is not supposed to transfer the entire core drug knowledge to patients. Diagnosis and outcome identification is a method to identify and label interactions between core drug knowledge and core patient variables. This exercise is generally done by nurses to help them identify adverse effects and their causes quickly and reliably. The vital signs of a patient do not need to be included in the patient education materials. Patient education materials essentially help a patient to administer drugs safely.
6. A 56-year-old female patient has been admitted to the hospital with chronic muscle spasms and has been prescribed a new medication to treat the spasms. She has a poorly documented allergy to eggs, synthetic clothes, and perfumes. What is the priority action of the nurse to ensure that prescribed medication does not experience an allergic reaction?
  A) Call the prescriber immediately regarding her allergic reactions
  B) Hold the medication for her muscle spasms until she can be treated for a possible allergic reaction
  C) Post an allergies notice on the front of the chart and document the allergies in the appropriate area of the patient’s record
  D) Call the dietary staff and make sure that the patient is not served eggs for breakfast
  Ans: C
  The nurse should post an allergies notice on the front of the chart and document the allergies in the appropriate area of the patient’s record; this will allow continuous access of the dietary staff and the other members of the health care team to the information and serve to limit errors. The prescriber would always ask the patient about her allergies before prescribing a new medication. The patient is not having an allergic reaction, so treating her for an allergic reaction is unnecessary. If the allergies are documented in the appropriate area of the patient’s record, the dietary staff will be aware that the patient should not be served eggs.
7. The nurse has been assigned a 49-year-old patient who has acute colitis, and the nurse just completed gathering data concerning core drug knowledge and core patient variables. To implement nursing management of drug therapy for this patient, the nurse will then
  A) evaluate the outcome of the drug therapy.
  B) devise strategies to maximize the therapeutic effects of the drug.
  C) implement planned nursing actions.
  D) assess for data that will indicate interactions between core drug knowledge and core patient variables.
  Ans: B
  After all the data are gathered during the assessment phase, the nurse will plan strategies to maximize the therapeutic effects of the drug therapy. After plans are made, the nurse will implement the actions in the intervention or implementation phase. Evaluation is initiated to determine if the planned actions helped the goal of therapeutic drug therapy. The assessment of the data is the first step in the process and was already completed with this patient.
8. Which of the following activities would the nurse expect to complete during the evaluation phase of the nursing process in drug therapy?
  A) Compare the outcome expected with the actual patient outcome
  B) Reconsider core drug knowledge and core patient variables
  C) Ask questions to prepare an effective patient education program
  D) Establish a baseline for the patient’s treatment and care
  Ans: A
  In the evaluation phase, a nurse would compare the expected outcome goals of the treatment with the patient’s progress, thereby judging the effectiveness of nursing management. Questions are generally asked initially at the onset of drug therapy and compiled. These questions serve as a basis for preparing the patient’s education program. During the assessment phase of core patient variables, the nurse physically examines the patient and establishes all baselines. The evaluation phase is not the right time to reconsider core patient variables and core drug knowledge because such critical information is essentially compiled in the assessment phase.
9. A nurse is caring for a postsurgical patient who has small tortuous veins and had a difficult IV insertion. The patient is now receiving IV medications on a regular basis. What is the best nursing intervention to minimize the adverse effects of this drug therapy?
  A) Monitor the patient’s bleeding time
  B) Check the patient’s blood glucose levels
  C) Record baseline vital signs
  D) Monitor the IV site for redness, swelling, or pain
  Ans: D
  Because the patient has small tortuous veins and had a difficult IV insertion, the patient is at high risk for infiltration of the IV site. Recording baseline vital signs or blood sugar level is an important nursing action, but not specific to IV administration of any drug. The patient is not known to take anticoagulants; so unless indicated, the nurse is not required to monitor the patient’s bleeding time.
10. A patient has been prescribed several drugs and fluids to be given intravenously. Before the nurse starts the intravenous administration, a priority assessment of the patient will be to note the
  A) heart rate.
  B) body weight and height.
  C) blood pressure.
  D) skin surrounding the potential IV site.
  Ans: D
  Baseline body weight and height, heart rate, and blood pressure are all important considerations during the assessment of a patient. However, if a patient has to be given drugs intravenously, it is important to inspect the skin for rashes, moles, or sores, so those areas can be avoided as an insertion or injection site.
11. A nurse is performing an admission assessment of an elderly patient who is being admitted to a medical ward from the emergency department. Which of the following is an open-ended assessment question?
  A) “Have you ever had a bad response to a drug that you’ve taken?”
  B) “Does anyone in your immediate family have a history of drug allergies?”
  C) “Are you comfortable with receiving needles?”
  D) “What kind of reactions have you had to medications?”
  Ans: D
  Open-ended questions cannot be logically answered with a “yes” or “no” response. They allow the nurse to elicit far greater detail than yes/no questions.
12. The nurse’s assessment of a community-dwelling adult suggests that the client may have drug allergies that have not been previously documented. What statement by the client would confirm this?
  A) “I tend to get sick in the stomach when I take antibiotics.”
  B) “I’ve been told that aspirin might have caused my stomach bleed a few years back.”
  C) “I broke out in hives and got terribly itchy when I started a new prescription last year.”
  D) “When I fell last year, the doctor said that it might have been because of my blood pressure pills.”
  Ans: C
  True allergic reactions include formation of rash or hives, itching, redness, swelling, difficulty breathing, and anaphylactic shock. Nausea and vomiting, however, are adverse effects of drug therapy. Similarly, an unsafe drop in blood pressure and gastric bleeding from aspirin use are adverse drug effects, not allergic reactions.
13. A nurse who provides care on a busy medical unit of a large hospital is constantly faced with new drugs on patients’ medication administration records. What strategy should the nurse employ to foster up-to-date information about the nursing management of new or uncommon drugs?
  A) Focus on learning about a prototype drug that is characteristic of a larger drug class
  B) Identify similarities between new drugs and older drugs that are commonly used on the unit
  C) Commit time and energy during each shift to learning about new drugs
  D) Liaise with pharmacists and pharmacy technicians who work at the hospital
  Ans: A
  An efficient way to learn and understand as much as possible of the vast information about drugs is to use a prototype approach. A prototype drug is typical of a group of drugs within a drug class. This strategy is more realistic and efficient than working with a pharmacist, studying during a shift or comparing new drugs to old drugs.
14. A patient who has been admitted to the hospital for a mastectomy has stated that she has experienced adverse drug effects at various times during her life. Which of the following strategies should the nurse prioritize in order to minimize the potential of adverse drug effects during the patient’s stay in the hospital?
  A) Administer the patient’s drugs in doses that are smaller and more frequent than ordered
  B) Monitor the patient vigilantly for signs and symptoms of potentially adverse drug effects
  C) Encourage the patient to bring herbal supplements and complementary remedies with her to the hospital
  D) Alter the administration of the patient’s medications in favor of the intravenous, rather than oral, route.
  Ans: B
  In an effort to minimize the potential of adverse drug effects, it is necessary to closely monitor the patient. It would be inappropriate for the nurse to alter the route or frequency of administration or to encourage herbal remedies that also carry the potential for adverse effects.
15. A surgical patient has been diagnosed with type 2 diabetes during his current admission to the hospital. The nurses and other members of the care team have attempted to engage the patient in education about his new diagnosis, the effects it will have on his lifestyle and the medications that will be necessary to treat it. However, the patient is unwilling to discuss these matters, usually citing fatigue or the desire to watch TV or make phone calls. What potential nursing diagnosis should the nurse prioritize?
  A) Ineffective coping
  B) Knowledge deficit
  C) Acute confusion
  D) Anxiety
  Ans: A
  A nursing diagnosis of ineffective coping may be plausible if a patient is unwilling to discuss his or her diagnosis or medication regimen. The patient’s behavior is unlikely to be motivated by a lack of knowledge or confusion. Anxiety may underlie such behavior, but this may or may not be the cause of poor coping.

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