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Test Bank Introduction to Clinical Pharmacology 10th Edition Cheryl Zambroski, Shirley Hosler Visovsky/ TEST BANK
INTRODUCTION
TO CLINICAL
PHARMACOLOGY
10TH EDITION
VISOVSKY
Chapter 01: Pharmacology and the Nursing Process in LPN Practice
Visovsky: Introduction to Clinical Pharmacology,
MULTIPLE CHOICE
1. You are assessing the skin of a newly admitted patient and note a 2 inch area of redness at the
sacrum. Which type of data are you collecting with this information?
a.
b.
Objective data
Inspection
c.
Subjective data
d.
Alternative therapy
ANS: A
Objective data are obtained by the healthcare provider during physical examination, or that are
measurable (i.e., laboratory results).
DIF: Cognitive Level: Applying REF: p. 3
Which part of the nursing process includes setting goals for the nursing care required when
giving drugs to a patient?
2.
a.
b.
c.
d.
Assessment
Planning
Evaluation
Diagnosis
ANS: B
The nursing process consists of five major steps in this order: assessment, diagnosis, planning,
implementation, evaluation. It is in the planning step that the goals for nursing care related to
drugs are set based upon data collected.
DIF: Cognitive Level: Remembering REF: p. 4
When would it be appropriate to withhold a drug instead of giving it to a patient?
3.
a.
b.
c.
d.
When the order is written by hand
When any part of the drug order is unclear
When the drug improves the patient’s symptoms
When the order contains both the generic and trade name of the drug
ANS: B
You must use good judgment in carrying out a drug order. If, in your judgment, the order is
unclear, or incorrect, it should be withheld (not given) until your concerns can be answered by
the patient’s healthcare provider.
DIF: Cognitive Level: Applying REF: p. 4
Which action would you take to ensure that an order for a drug is accurate?
4.
a.
b.
c.
d.
Check the drug record with the Kardex file.
Compare the order with the drug history.
Compare the order to the patient’s reason for admission.
Check the drug record with the original healthcare provider’s order.
ANS: D
Once the healthcare provider orders the drug, you must verify that the order is accurate. This
is done by checking the drug chart or drug record with the healthcare provider’s original order.
DIF: Cognitive Level: Remembering REF: p. 4
5. What do the nine “rights” of drug administration include?
a.
Right patient, drug, dose, route, time, reason, documentation, response, and right to
refuse
Right drug, diagnosis, time, patient, route, drug history, documents, and right to
refuse
Right drug, amount, route, time, nurse, reason, route, diagnosis, and documentation
Right dose, time, healthcare provider, patient, route, documentation, response, and
drug
b.
c.
d.
ANS: A
There are nine “rights” of drug administration: you must identify the right patient, give the
right drug at the right dose, right route, right time, for the right reason, using the right
documentation to record that the dose has been given, monitor the patient for the right
response, and note that the patient has the right to refuse a drug.
DIF: Cognitive Level: Remembering REF: p. 5
Which action should you take to ensure that you are giving a drug to the right patient?
6.
a.
b.
c.
d.
Verifying the drug record with the patient name on the chart
Verifying the patient’s room and bed number with the chart
Asking the patient to state his or her birthdate and Social Security number
Asking the patient to state their name and birthdate, and then checking the patients
identification bracelet
ANS: D
Before giving any drug, two forms of patient identifications should be used to identify the
correct patient. Each patient should be asked his or her name, and another form of
identification, such as birthdate; then you should check the patient’s identification bracelet.
DIF: Cognitive Level: Applying REF: p. 5
Which category of drugs should be given exactly on schedule in order to maintain a consistent
level of the drug in the body?
7.
a.
b.
c.
d.
Steroids
Diuretics
Aspirin products
Anticoagulants
ANS: D
Certain drugs must be given at specific time interval (right time). Anticoagulants must be
given at the same time each day to maintain a therapeutic blood level in order to prevent
blood clots.
DIF: Cognitive Level: Applying REF: p. 7
8. Which nursing action is not appropriate when giving drugs to a patient?
a.
b.
c.
d.
Leaving the drug at the patient’s bedside to take when he/she awakens
Asking the patient if he or she has any allergies to drugs
Checking a drug reference to verify the action of the drug
Explaining to the patient the possible side effects of the drug
ANS: A
It is never permissible to leave drugs at the patient’s bedside. As the nurse, you are responsible
for witnessing the patient taking the drug(s), or documentation of the patient’s refusal.
DIF: Cognitive Level: Applying REF: p. 10
Which of the following nursing actions is an example of evaluating patient responses to drug
therapy?
9.
a.
b.
c.
d.
Documenting the fact that the patient refused the drug
Making sure you have assembled all necessary equipment
Taking the patient’s blood pressure before giving an antihypertensive
Taking the temperature of a patient an hour after giving an antipyretic
ANS: D
Evaluation is the process of determining the right response of the patient to the drug given.
The correct response to an antipyretic is a reduction in fever.
DIF: Cognitive Level: Knowing REF: p. 9
Which statement is considered to be an example of objective data gathered in the assessment
of a patient who will be receiving drugs for the treatment of an injury?
10.
a.
The patient’s skin is warm and dry to touch.
b.
The patient tells you “I have pain in my lower back.”
c.
d.
The patient states he is having trouble catching his breath.
The patient checks off “no history of drug allergies” on the health form.
ANS: A
Objective data are physical findings the nurse can see during careful inspection, palpation,
percussion, and auscultation.
DIF: Cognitive Level: Knowing REF: p. 3
You are interviewing a patient to obtain a current drug history. What information should be
part of this report?
11.
a.
b.
c.
d.
The color of each drug in pill form
The names and dosages of each drug
The major health conditions of the patient
The nursing diagnoses that come from the collected information
ANS: B
In the interview to obtain a current and accurate drug history, the names of each drug and, if
possible, the dosage of each drug are recorded.
DIF: Cognitive Level: Applying REF: p. 3
12. Apatient you are caring for is prescribed 30 units of NPH insulin to be given subcutaneously.
You know that insulin is considered a “high-alert drug.” What nursing action would you
perform to give a high-alert drug safely?
a.
b.
c.
d.
Call the healthcare provider to double check the order.
Ensure an insulin level is drawn before giving the drug.
Have another nurse check the order and dosage before giving it.
Refuse to give this drug, as it can only be given by a registered nurse.
ANS: C
Many institutions have policies that require two nurses to double check the order and dosages
of high-alert drugs to reduce the risk of error and adverse effects for the patient. This is
especially important if the drug dose needs to be calculated.
DIF: Cognitive Level: Applying REF: p. 8
You are about to give the prescribed drugs to a patient in your care. When you approach the
patient with the drugs, the patient refuses to take one of the drugs. What is your best action?
13.
a.
b.
c.
d.
Ask the pharmacy if there is a substitute drug for the one the patient refused.
Acknowledge to patient’s right to refuse, no other action is needed.
Let the patient know the consequences of refusing the drug.
Notify the charge nurse or healthcare provider.
ANS: D
Never record drugs that were not given or record them before they are given. If a patient does
not receive the drug for any reason, notify the nurse in charge or the healthcare provider
according to your healthcare setting policies.
DIF: Cognitive Level: Applying REF: p. 8
You have given the antibiotic penicillin as prescribed to a patient with no reported drug
allergies. Thirty minutes after receiving the drug, the patient notifies you that he/she has
developed hives and swelling of the lips. What is your best first action?
a.
Call the pharmacy and report this as an adverse reaction to the drug.
14.
b.
c.
d.
Immediately give epinephrine to counter the drug reaction.
Reassure the patient that this is a typical side effect of the drug.
Report the findings to the RN or healthcare provider and remain with the patient.
ANS: D
If you suspect the patient is having an adverse effect, such as an allergic reaction, report this
immediately to the RN or healthcare provider. Remain with the patient, monitoring for
changes in breathing or vital signs, until the RN or healthcare provider arrives with additional
orders to be carried out.
DIF: Cognitive Level: Applying REF: p. 9
You are working on a very busy 35-bed hospice unit. The RN you are working with just got a
new admission and hands you a syringe with “pain drug” in it. He/she asks you to give this
drug to a specified patient. What is your most appropriate action?
15.
a.
b.
c.
Assist the RN by giving the drug as requested for this one time only.
Refuse to give a drug that is not for a patient you are assigned to care for.
Refuse, but prepare another dose of the drug yourself, and give as prescribed.
d.
Assist the RN as directed, as under the RN’s supervision, this practice is permitted.
ANS: C
You are never to give a drug prepared by another nurse, even during a busy time or during an
emergency. To meet all the patient safety standards covered by the “9 Rights,” you are
required to give only drugs you have prepared.
DIF: Cognitive Level: Applying REF: p. 7
16. You are evaluating the response of a patient 30 minutes after receiving an antihypertensive
drug. Upon assessment of the patient’s blood pressure, you note the patient has become
hypotensive. What type of drug effect is this patient experiencing?
a.
b.
c.
d.
An adverse effect of the drug
Aside effect of the drug
Atherapeutic effect of the drug
An allergic reaction to the drug
ANS: A
An adverse effect is seen when patients do not respond to drugs in the way they should, or
develop new signs or symptoms. When a patient has an adverse effect, you should report this
immediately to the RN or healthcare provider.
DIF: Cognitive Level: Knowing REF: p. 9
MULTIPLE RESPONSE
1. Before giving a drug to a patient which steps should you take to ensure safe drug
administration? (Select all that apply.)
a.
b.
c.
d.
e.
f.
Use two forms of patient identification.
Ask the patient about any drug allergies.
Check the drug before removing it from the unit-dose cart.
Check the dose before preparing or measuring the drug.
Check the drug just before you open it and give it to the patient.
Document the drug given before you enter into the patient’s room.
ANS: A, B, C, D, E
The nurse needs to use two forms of identification to ensure the drug is given to the right
patient. The nurse should read the drug label at least three times: (1) before taking the drug
from the unit-dose cart or shelf, (2) before preparing or measuring the prescribed dose of drug,
and (3) before giving it to the patient. Asking about drug allergies is important if this
information is not available, or if drugs associated with allergic reactions, such as antibiotics,
are given.
DIF: Cognitive Level: Applying REF: p. 10
You are taking the drug history from a patient. Which of the following information should be
collected as part of this interview? (Select all that apply.)
2.
a.
b.
c.
d.
Allergies to any drugs
Alcohol or recreational drug use
The time of day preferred for taking drugs
The use of nutritional supplements or herbs
e.
f.
The strategies you will use to care for the patient
The illness or symptoms for which the drug is needed
ANS: A, B, D, F
The patient’s drug history consists of symptoms or diseases for which a drug is needed, the
names, and dosages of all drugs, alcohol or recreational drug history, and alternative
treatments, such as nutritional or herbal therapies.
DIF: Cognitive Level: Applying REF: p. 3
3. When evaluating a patient’s response to s drug, which factors should you should consider?
(Select all that apply.)
a.
b.
c.
d.
e.
f.
The clarity of all written drug orders
The expected side effects of the drug
The reason the drug was prescribed
The therapeutic effects of the drug
The timing of the prescribed drug
The adverse effects of the drug
ANS: B, D, E
The three factors to be considered in evaluating responses to drug therapy are the therapeutic
effects, expected side effects, and adverse effects.
DIF: Cognitive Level: Remembering REF: p. 9
Chapter 02: Legal, Regulatory, and Ethical Aspects of Drug Administration
Visovsky: Introduction to Clinical Pharmacology,
MULTIPLE CHOICE
1. Which of the following scenarios may be a sign of possible drug diversion on a unit?
a.
b.
c.
d.
Apatient is dissatisfied with the drug administration schedule.
Apatient receiving oral antibiotics has an excess amount of pills.
Apatient is unaware that the nurse mixed a drug in applesauce.
Apatient receiving opioids reports increased pain.
ANS: D
Drug diversion is defined as the illegal transfer of regulated drugs (like narcotics) from the
patient for whom it was prescribed, to another person, such as a nurse, for their own (or
others) use. Drug diversion should also be suspected if patients continually report pain despite
appropriate drug treatment, and if inaccurate narcotic counts are noted.
DIF: Cognitive Level: Remembering REF: pp. 13-14
Which of the following is an example of psychological dependence (addiction) to a drug?
2.
a.
b.
c.
d.
Symptoms of drug withdrawal
Pain, confusion, and seizures
An intense mental desire for certain drugs
Shaking and an increased heart rate after taking a drug
ANS: C
Psychological dependence, or addiction, is a mental desire associated with taking certain
substances, such as cocaine or alcohol. Symptoms of mental dependence such as anxiety,
anger, or depression can occur with psychological dependence.
DIF: Cognitive Level: Remembering REF: p. 12
You have obtained a liquid narcotic for a patient in pain from the unit’s locked cabinet.
However, the dose was accidentally spilled before to giving it to the patient. What is the best
action to take at this point?
3.
a.
b.
c.
Ask another nurse to cosign the inventory record describing the situation.
Immediately obtain another dose from the narcotic control system.
Document the occurrence in the drug record.
d.
Clean up the spill and notify the supervisor.
ANS: A
Accounting for controlled substances is a legal requirement. If the drug is accidentally
dropped, contaminated, or spilled two nurses must sign the inventory report and describe the
situation.
DIF: Cognitive Level: Knowing REF: p. 14
4. As you arrive to work, a nurse from the previous shift tells you that she has completed the
narcotic count for your shift. What action should be taken?
a.
b.
There is no need for any additional action as this is the standard procedure.
Accept the keys to the narcotic cabinet and recount the drugs yourself.
c.
Recount the narcotics again with a nurse from the previous shift.
d.
Recount the drugs yourself at the end of your shift.
ANS: C
At the end of each shift, the contents of the locked cabinet are counted together by one nurse
from each shift in order to verify the narcotics count. If not done properly, the nurse risks
being held accountable for any shortages or discrepancies, and may be found guilty of
falsifying the narcotic count records.
DIF: Cognitive Level: Applying REF: p. 14
Aone-time order for a controlled substance drug has been written for a patient you are caring
for. However, the drug ordered is available only in a larger dose than is needed. What should
you do with the remaining drug?
5.
a.
b.
c.
d.
Give the full dose that is available.
Flush the remaining drug in the toilet of the patient’s bathroom.
Save the remaining drug in case the patient needs it again.
Have another nurse witness the wasting of the leftover drug, and document
according to policy.
ANS: D
If the ordered dose is smaller than the dose provided (so that some drug must be discarded),
two nurses witness the wasting of the drug and sign the controlled substance inventory report
according to institution policy.
DIF: Cognitive Level: Knowing REF: p. 14
An elderly patient in an assisted living home requests an over-the-counter cough preparation
for a mild couch she is experiencing. What is your best response?
6.
a.
“I do not have any of this drug for you at this time, but can give you a dose from
another patient’s supply.”
“I will bring it to you right away, but I must keep it with your other prescription
drugs.”
“I will need to contact your healthcare provider for an order before I can give this
drug to you.”
“You may have this, but your family will need to bring it in for you.”
b.
c.
d.
ANS: C
Over-the-counter (OTC) drugs do not require a prescription for purchase, but a healthcare
provider’s order is required before it can be given by the LPN/LVN in an institutional setting.
OTC drugs may interact with a patient’s prescribed drugs, especially in the elderly.
DIF: Cognitive Level: Applying REF: p. 15
7. Which of the following orders is an example of a single drug order?
a.
b.
c.
d.
Atenolol 50 mg orally daily
Morphine sulfate 4 mg IV stat Cefazolin
1 g IV 8 a.m. before surgery Tramadol 50
mg orally as needed for pain
ANS: C
Asingle drug order is a drug that is scheduled to be given at a specified time for one dose
only.
DIF: Cognitive Level: Knowing REF: p. 16
Diphenhydramine 50 mg IV push is ordered by the healthcare provider to be given “stat.”
When should this drug be given?
8.
a.
b.
c.
d.
Immediately
As need upon the patient’s request
Within one hour of receiving the order
When you have completed giving the oral drugs first
ANS: A
Astat order is a type of drug order that is to be given immediately.
DIF: Cognitive Level: Knowing REF: p. 16
You are giving drugs to the patients assigned to you when you realize that you gave a drug to
the wrong patient. What action should you take?
9.
a.
b.
c.
d.
Evaluate the patient’s condition and notify the healthcare provider.
Submit a report only if the patient has an adverse reaction.
Inform the patient and complete an incident report.
Document the occurrence in the patient record.
ANS: A
When it is discovered that an error has been made, you should immediately evaluate the
patient for any adverse reactions and notify the healthcare provider as soon as possible. An
incident report should be completed and the supervisor notified.
DIF: Cognitive Level: Applying REF: p. 19
MULTIPLE RESPONSE
1. Which of the following drugs is considered a high-alert drug? (Select all that apply.)
a.
b.
c.
d.
e.
f.
Percocet
Insulin
Heparin
Herceptin
Potassium
Indomethacin
ANS: B, C, E
Categories of common high-alert drugs can be remembered using the acronym “PINCH.” P is
for potassium, I is for insulin, N is for narcotics (opioids), C is for cancer chemotherapy drugs,
and H is for heparin or any drug type that interferes with blood clotting.
DIF: Cognitive Level: Remembering REF: p. 19
2. Which of the following actions should you take before you give a drug mixed into food or the
mixing of drugs with food or drink must be documented in the patients care plan, and on the
drug administration chart to address the legal aspects of this practice a drink? (Select all that
apply.)
a.
b.
c.
d.
e.
f.
Check a drug handbook.
Inform the patient or family.
Inform the healthcare provider.
Thoroughly crush pills with an enteric coating.
Document the mixing of drugs in food or drink in the chart.
Give the prescribed drug mixed in food during a regular patient meal.
ANS: A, B, C, E
Covert drug administration is discouraged. Therefore, nurses are under obligation to inform
the healthcare provider, who ordered the drug, and the patient or family. Some drugs may not
be mixed with certain foods or drinks, or may not be crushed, so checking the drug handbook
is a necessary step to ensure patient safety. The mixing of drugs with food or drink must be
documented in the patients care plan, and on the drug administration chart to address the legal
aspects of this practice.
DIF: Cognitive Level: Applying REF: p. 12
Which steps should you take to identify possible drug errors in a patient’s drug orders? (Select
all that apply.)
3.
a.
b.
c.
d.
e.
f.
Call the pharmacy.
Clarify anything that is unreadable
Ask the patient about the drug.
Reconcile the drug list with an old drug record.
Clarify vague orders with the healthcare provider.
Check the original written order with the healthcare provider.
ANS: A, B, E, F
Checking with a reliable source, such as the pharmacist, clarifying vague orders or anything
that is difficult to read (if handwritten) and checking the original written order are all ways to
avoid drug errors.
DIF: Cognitive Level: Applying REF: p. 17
Which levels of regulation must you adhere to when giving drugs to a patient? (Select all that
apply.)
4.
a.
b.
c.
d.
City Regulations
State Regulations
County Regulations
Federal Regulations
e.
f.
Institutional Regulations
Health Insurance Regulations
ANS: B, D, E
Nurses who are responsible for giving drugs to patients in their care have three levels of
regulations to follow: federal (describes and controls), state (regulates who dispenses), and
individual hospital or agency (additional guidelines or policies).
DIF: Cognitive Level: Remembering REF: pp. 14-16
Anarcotic control system is used in any hospital or agency. Which of the following are special
regulations applied for control of narcotics that you must follow? (Select all that apply.)
5.
a.
b.
c.
d.
e.
f.
Narcotics are stored in a special locked cabinet.
Narcotic control is the responsibility of everyone on the unit.
Narcotics may be borrowed from patient to patient for emergency use.
You may return unused narcotics to the patient’s family upon discharge.
You are responsible for signing out every narcotic drug used for a patient.
An inventory of the narcotics on a unit must be kept and verified by two nurses.
ANS: A, E, F
Narcotics are stored in special, limited-access, locked cabinets. Anurse records all controlled
substance drug during the shift. The inventory report form is completed before the drug is
removed from the cabinet.
DIF: Cognitive Level: Applying REF: pp. 12-13
Adiscrepancy in the narcotics inventory for morphine 5 mg/mL vials is discovered when the
narcotics count is performed. The count is short by one vial. Which of the following steps
should you take to reconcile the count? (Select all that apply.)
6.
a.
b.
c.
d.
e.
f.
No action needs to be taken for small discrepancies.
Notify the nursing supervisor and the pharmacy of the discrepancy.
Identify if any nurse forgot to record any of the narcotics removed.
Ask only the nurses who used narcotics about the drugs they have given.
Check drug records to reconcile if narcotics given and not signed for.
Notify the security department of the institution if drug diversion is suspected.
ANS: B, C, E, F
All nurses must be asked about narcotics that may have been given. Steps must be retraced to
see if someone forgot to record any drug. Patient charts might also be checked to see if drug
was given that was not signed for on the inventory report. If errors in the report cannot be
found, both the pharmacy and the nursing service office must be notified. If drug diversion is
suspected, the hospital administrator and security police are usually contacted.
DIF: Cognitive Level: Applying REF: pp. 12-14
Chapter 02: Legal, Regulatory, and Ethical Aspects of Drug Administration
Visovsky: Introduction to Clinical Pharmacology,
MULTIPLE CHOICE
Which of the following scenarios may be a sign of possible drug diversion on a unit?
1.
a.
A patient is dissatisfied with the drug administration schedule.
b.
A patient receiving oral antibiotics has an excess amount of pills.
c.
d.
A patient is unaware that the nurse mixed a drug in applesauce.
A patient receiving opioids reports increased pain.
ANS: D
Drug diversion is defined as the illegal transfer of regulated drugs (like narcotics) from the
patient for whom it was prescribed, to another person, such as a nurse, for their own (or
others) use. Drug diversion should also be suspected if patients continually report pain despite
appropriate drug treatment, and if inaccurate narcotic counts are noted.
DIF: Cognitive Level: Remembering REF: pp. 13-14
Which of the following is an example of psychological dependence (addiction) to a drug?
2.
a.
Symptoms of drug withdrawal
b.
Pain, confusion, and seizures
c.
An intense mental desire for certain drugs
d.
Shaking and an increased heart rate after taking a drug
ANS: C
Psychological dependence, or addiction, is a mental desire associated with taking certain
substances, such as cocaine or alcohol. Symptoms of mental dependence such as anxiety,
anger, or depression can occur with psychological dependence.
DIF: Cognitive Level: Remembering REF: p. 12
You have obtained a liquid narcotic for a patient in pain from the unit’s locked cabinet.
However, the dose was accidentally spilled before to giving it to the patient. What is the best
action to take at this point?
a.
Ask another nurse to cosign the inventory record describing the situation.
b.
Immediately obtain another dose from the narcotic control system.
3.
c.
d.
Document the occurrence in the drug record.
Clean up the spill and notify the supervisor.
ANS: A
Accounting for controlled substances is a legal requirement. If the drug is accidentally
dropped, contaminated, or spilled two nurses must sign the inventory report and describe the
situation.
DIF: Cognitive Level: Knowing REF: p. 14
As you arrive to work, a nurse from the previous shift tells you that she has completed the
narcotic count for your shift. What action should be taken?
4.
a.
There is no need for any additional action as this is the standard procedure.
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