Pharmacology for Nursing Care, 7th Edition by Richard A. Lehne – Test Bank

Pharmacology for Nursing Care, 7th Edition by Richard A. Lehne – Test Bank

Lehne: Pharmacology for Nursing Care, 7^th Edition

Chapter 7: Adverse Drug Reactions and Medication Errors

Test Bank

1. An hour after taking a medication, a nurse notes that the patient displays urticaria and pruritus. The nurse’s priority action for this patient would be to

a.

leave the patient to call the prescriber.

b.

assess for changes in respiratory pattern and wheezing.

c.

document the findings.

d.

administer epinephrine to the patient STAT.

ANS: B

Patients who develop urticaria (hives) and pruritus are at risk for anaphylaxis, which would be indicated by bronchoconstriction and wheezing. Note: As a test strategy, when answering a priority question, make sure you go through the ABCs, then other physiological priorities, then safety and security priorities, then love and belonging priorities. This is clearly an ABC priority.

Never leave the patient, because the allergic reaction may precipitate anaphylaxis, and you would need to assess for changes in respiratory status.

Simply documenting the findings ignores the patient risk for anaphylaxis.

Epinephrine should be administered only in the event of anaphylaxis.

DIF: Cognitive Level: Application REF: p. 64

TOP: Nursing Process: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity: Reduction of Risk Potential

2. A nurse administered morning medications an hour ago. While assessing a patient who has just been started on a new medication, the nurse notes that the patient is exhibiting an uncommon drug response resulting from a genetic predisposition. The nurse recognizes this as (a)n _____ effect.

a.

idiosyncratic

b.

iatrogenic

c.

teratogenic

d.

carcinogenic

ANS: A

An idiosyncratic drug response is due to a genetic predisposition.

An iatrogenic drug response is one that causes a disease secondary to the drug.

A teratogenic drug response is one that causes fetal harm.

A carcinogenic drug response is one in which a drug is able to cause cancer.

DIF: Cognitive Level: Analysis REF: p. 65

TOP: Nursing Process: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

3. A nurse is reviewing the medication administration record (MAR) prior to administration of medications. Which order should the nurse implement?

a.

Furosemide (Lasix) 20 mg QD PO

b.

Furosemide (Lasix) 20.0 mg qd PO

c.

Furosemide (Lasix) 20.0 mg daily

d.

Furosemide (Lasix) 20 mg PO daily

ANS: D

This is a complete order; it contains the medication, dose, route, and time.

QD is no longer an accepted abbreviation; it should be written out as “daily” or “every day.”

qd is no longer an accepted abbreviation; it should be written out as “daily” or “every day.”

This order does not specify the route to be used.

DIF: Cognitive Level: Analysis REF: p. 72

TOP: Nursing Process: Planning

MSC: NCLEX Client Needs Category: Physiological Integrity: Reduction of Risk Potential

4. A nurse has a busy morning and is rushed. While administering medications, the nurse realizes that he has made a medication error. Which action should the nurse take first?

a.

Report the medication error to the charge nurse and fill out an incident report.

b.

Assess the patient for any adverse reactions to the medications and notify the prescriber.

c.

Document in the patient’s notes the medication given and that an error was made.

d.

Explain to the patient that a medication error has occurred and notify the nurse manager.

ANS: B

Assessment of the patient is always the priority. Once all assessment data have been collected, the prescriber should be notified.

Ensuring the patient’s safety is the priority, not reporting the medication error.

Medication errors are reported on incident reports, not in the patient’s notes, and this is not the highest priority.

Assessment of the patient is the priority and should be done first.

DIF: Cognitive Level: Application REF: pp. 69-70

TOP: Nursing Process: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity: Reduction of Risk Potential

5. A patient is admitted to your unit with hepatomegaly secondary to hepatitis. When conducting patient education, the nurse should counsel the patient to

a.

avoid alcohol and acetaminophen.

b.

have monthly liver enzymes drawn.

c.

measure the abdominal girth to monitor liver enlargement and report findings to the prescriber.

d.

discontinue use of all drugs metabolized in the liver.

ANS: A

Acetaminophen (Tylenol) and alcohol are contraindicated in a patient with liver problems, because both increase the risk for hepatotoxicity.

Having liver enzymes drawn monthly is too frequent; they usually are drawn every 3 months. Although important, they are not the most important piece of information to teach related to the daily activities of the patient.

Measurement of the abdominal girth to monitor for liver enlargement is a nursing intervention, not a patient intervention.

Discontinuation of all drugs metabolized in the liver is not feasible, because most are metabolized by the liver.

DIF: Cognitive Level: Application REF: p. 66

TOP: Nursing Process: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity: Reduction of Risk Potential

6. Two hours after taking a dose of penicillin, a patient arrives in the emergency department with complaints of slight shortness of breath, respirations 28/minute. Upon further assessment, a nurse observes pruritus and urticaria, BP 92/48, respirations 36/min. Select the most likely analysis of the situation.

a.

The patient is experiencing a moderate allergic reaction that will improve as the nurse applies oxygen.

b.

The patient is having a mild reaction that can be treated efficiently with administration of an antihistamine.

c.

These symptoms are most likely the result of another cause, because fewer than 10% of patients have true allergic responses.

d.

The patient is experiencing an anaphylactic response, and emergency interventions should be employed.

ANS: D

The signs and symptoms the patient is experiencing reveal an anaphylactic response to the antibiotic, a possibly life-threatening development.

Providing oxygen will not reduce the risk of the potentially life-threatening anaphylaxis.

Anaphylaxis is a potentially life-threatening condition that needs to be treated immediately. It is not mild and cannot be managed by an antihistamine alone.

The assumption cannot be made that the reaction is due to another cause.

DIF: Cognitive Level: Analysis REF: pp. 64-65

TOP: Nursing Process: Evaluation

MSC: NCLEX Client Needs Category: Physiological Integrity: Reduction of Risk Potential

7. A patient has been treated with opioids for a year to manage back pain. After successful surgery, the patient’s pain is greatly improved. The patient reports, “I stopped taking my pain medication when I got home from the hospital, but I got very sick with diarrhea and generalized pain.” Select the nurse’s best response.

a.

“This is a common idiosyncratic effect. Over-the-counter antidiarrheals and nonsteroidal agents will help you ride it out.”

b.

“Restart the pain medication. It is now required for life because you have tolerance toward opioids.”

c.

“You are experiencing toxicity from the drugs used during the hospitalization and will need to be rehospitalized.”

d.

“Your reaction is associated with physical dependence on opioids. We will design a tapering dose schedule to avoid the withdrawal symptoms.”

ANS: D

The patient is experiencing withdrawal from a dependence on opioids, and a tapering schedule must be instituted to prevent the symptoms.

The description by the patient is not indicative of an idiosyncratic effect.

Pain medication is not required lifelong; this will enhance the tolerance problem, not manage it.

The patient is not experiencing toxicity, but rather withdrawal symptoms.

DIF: Cognitive Level: Analysis REF: p. 65

TOP: Nursing Process: Evaluation

MSC: NCLEX Client Needs Category: Physiological Integrity: Reduction of Risk Potential

8. Most patients who receive succinylcholine (Anectine) as a muscle paralyzer have a brief response that lasts only a few minutes. A patient who experiences a very prolonged effect from the drug at a standard dosage is experiencing a(n)

a.

anaphylactic reaction.

b.

idiosyncratic effect.

c.

iatrogenic response.

d.

physical dependence.

ANS: B

An idiosyncratic effect occurs as an uncommon drug response resulting from a genetic predisposition.

An anaphylactic reaction occurs when there is an immune response by the body to a medication or allergen that causes the patient to experience bronchoconstriction, hypotension, and urticaria.

An iatrogenic response occurs when a disease or health alteration is caused by a drug.

Physical dependence occurs when the patient experiences a physical need for a drug; this is commonly seen with opioids.

DIF: Cognitive Level: Application REF: pp. 64-65

TOP: Nursing Process: Diagnosis

MSC: NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

9. Two hours after taking a dose of penicillin, a patient arrives in the emergency department complaining of tightness in the throat, pruritus, and red wheals. During the physical assessment, the patient develops difficulty breathing, respirations 36/min, blood pressure 90/42, pulse rate of 120/min. The priority nursing action would be to

a.

administer diphenhydramine (Benadryl), because the patient is experiencing a moderate allergic reaction that should improve shortly.

b.

sit the patient up in bed, administer oxygen until the symptoms subside, and notify the prescriber.

c.

question the patient about any previous allergy to penicillin and report the symptoms to the prescriber.

d.

call for assistance, apply oxygen, administer epinephrine as ordered, and notify the prescriber.

ANS: D

The patient is experiencing anaphylaxis, and emergency care must be provided.

Diphenhydramine is most effective when used to manage an allergic reaction that does not include anaphylaxis. This is a life-threatening situation, and emergency care must be provided.

Positional changes and oxygen are not the priority care needed in this situation.

Questioning the patient at this time is inappropriate and disregards the emergency nature of the situation.

DIF: Cognitive Level: Application REF: pp. 64-65

TOP: Nursing Process: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity: Reduction of Risk Potential

10. A nurse is providing education to the unit on adverse drug reactions to reduce the number of medication errors. After the teaching has been conducted, the nurse asks, “Which factor is a primary determinant of the intensity of an allergic drug reaction?” The participants’ best response would be the

a.

dose of drug ingested.

b.

body surface area of the patient.

c.

patient’s degree of compliance.

d.

degree of sensitization.

ANS: D

The intensity of an allergic reaction is determined primarily by the degree of sensitization of the immune system, not by drug dosage.

The intensity of an allergic reaction is largely independent of dosage. The dose of the drug is not necessarily related to whether the patient experiences an allergic reaction.

The body surface area is used to determine dose and is not a primary determinant of an allergic reaction.

The patient’s degree of compliance is not relevant to the development of an allergic reaction.

DIF: Cognitive Level: Comprehension REF: pp. 64-65

TOP: Nursing Process: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

11. A nurse is trying to determine whether a patient has experienced an adverse drug reaction. Which question would most likely assist the nurse in this determination?

a.

Did the patient notice that the drug caused a bad taste in the mouth?

b.

Did the patient’s symptoms appear shortly after the drug was first used?

c.

Is the patient complaining about the frequency of drug dosing?

d.

Has the drug produced this effect in another patient receiving the same agent at the same dose?

ANS: B

Symptoms that appear shortly after a drug is administered are likely related to the medication and indicative of an adverse reaction.

A bad taste in the mouth is usually considered a side effect of certain medications and is not indicative of an adverse reaction in most cases.

Frequency of drug dosing is not typically associated with adverse drug reactions.

All patients do not react the same to medications, even the same medications.

DIF: Cognitive Level: Analysis REF: pp. 66-67

TOP: Nursing Process: Evaluation

MSC: NCLEX Client Needs Category: Physiological Integrity: Pharmacological and Parenteral Therapies

12. While preparing a drug for administration, a nurse is asked a question by the nursing assistant, is greeted by visitors coming to see a hospitalized patient, and receives a telephone call. To promote safety, which action should the nurse take in this situation?

a.

The nurse should instruct the nursing assistant not to interrupt while he is preparing medications, because that may result in a medication error.

b.

The nurse should review the six rights of medication administration, because the events were distracting and therefore increased the likelihood of a medication error.

c.

The nurse should refer the visitors to the secretary to reduce interruptions during the process of medication administration.

d.

The nurse should not accept telephone calls during the process of medication administration.

ANS: B

The most effective way to promote safety and reduce the chance of medication errors is to review the six rights of medication administration for every medication situation; even more vigilance is needed when interruptions have occurred.

Although instructing the nursing assistant not to interrupt during the med pass is important, it should not be an absolute, because an interruption may be necessary in an emergency.

Visitor interruptions are situational and may be unavoidable in some cases. The most effective way to promote safety during medication administration is to review the six rights of medication administration.

Not accepting phone calls during the medication pass would promote safety but is not always feasible; therefore, the nurse should implement the six rights of medication administration to ensure safe medication delivery.

DIF: Cognitive Level: Application REF: p. 71 | p. 73

TOP: Nursing Process: Implementation

MSC: NCLEX Client Needs Category: Safe and Effective Care Environment: Management of Care

13. A nurse is reviewing the six rights of medication administration. Which medication order is written correctly?

a.

Regular insulin 10 units SubQ q AM

b.

Regular insulin 10U subQ q AM

c.

Regular insulin 10 units SQ q AM

d.

Regular insulin 10.0 units subQ q AM

ANS: A

Regular insulin 10 units SubQ q AM is correct, because it uses correct and approved abbreviations.

Units should be written out; the use of “U” is incorrect, because it is an unapproved abbreviation.

SQ is not an approved abbreviation; SubQ should be used instead.

The use of a trailing zero is no longer approved; 10.0 should be written as 10.

DIF: Cognitive Level: Comprehension REF: p. 72

TOP: Nursing Process: Diagnosis

MSC: NCLEX Client Needs Category: Safe and Effective Care Environment: Management of Care