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LEHNE’S PHARMACOTHERAPEUTICS FOR ADVANCED PRACTICE NURSES AND PHYSICIAN ASSISTANTS 2ND EDITION ROSENTHAL TEST BANK.

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  • 19 februari 2024
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Voorbeeld van de inhoud

LEHNE’S PHARMACOTHERAPEUTICS FOR
ADVANCED PRACTICE NURSES AND PHYSICIAN
ASSISTANTS 2ND EDITION ROSENTHAL TEST
BANK.
. A 11-year-old boy received all childhood immunizations before attending school as a
kindergartner. Which vaccines are recommended for this child at his current age?
a. DTaP, MCV4, Varivax
b. PCV-23, Td, MMR
c. Tdap, MCV4, HPV
d. Tdap, Varivax, hepatitis B - ansANS: C
At age 11, both males and females should receive a booster of diphtheria, tetanus, and
pertussis (Tdap); the Menactra vaccine against meningitis (MCV4); and the human
papillomavirus (HPV) vaccine. A Varivax booster is not recommended at this age. The
PCV-23 vaccine is indicated only in high-risk patients. The Tdap can be given, but a
vaccine with a pertussis component is preferred. The MMR is not given at this age. The
hepatitis B vaccine is not given at this age.DIF: Cognitive Level: ApplicationREF: p.
583TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category:
Physiologic Integrity: Health Promotion and Maintenance

. A nurse is reviewing an older adult patient's chart before giving medications. Which
patient information is of most concern?
a. Chronic constipation
b. Increased body fat
c. Low serum albumin
d. Low serum creatinine - ansANS: C
Low serum albumin reduces protein binding of drugs and can cause levels of free drug
to rise, increasing the risk of toxicity. Altered gastrointestinal (GI) absorption is not a
major factor in drug sensitivity in the older adult, although delayed gastric emptying can
delay drug responses. Increased body fat can alter drug distribution, causing reduced
responses in lipid-soluble drugs, however, it is not the finding of greatest concern to the
nurse. Low serum creatinine is a function of decreased lean muscle mass in older
patients and does not reflect kidney function or drug excretion.DIF: Cognitive Level:
ApplicationREF: p. 69TOP: Nursing Process: Diagnosis MSC: NCLEX Client Needs
Category: Physiologic Integrity: Physiologic Adaptation

2. A child will receive 750 mg of an antibiotic for 10 days. The child attends day care.
The drug may be dosed in several ways and is available in two concentrations. Which
dosing regimen will the nurse discuss with the child's provider?
a. 250 mg/5 mL to 375 mg PO twice daily
b. 250 mg/5 mL to 250 mg PO three times daily
c. 500 mg/5 mL to 250 mg PO three times daily
d. 500 mg/5 mL to 375 mg PO twice daily - ansANS: D
To promote adherence to a drug regimen in children, it is important to consider the size
and timing of the dose. In this case the preparation containing 500 mg/5 mL means that
a smaller volume can be given, which is more palatable to a child. Twice daily dosing is
more convenient for parents, especially when a child is in day care or school; it also

,LEHNE’S PHARMACOTHERAPEUTICS FOR
ADVANCED PRACTICE NURSES AND PHYSICIAN
ASSISTANTS 2ND EDITION ROSENTHAL TEST
BANK.
helps prevent the problem of the medication being left either at home or at school.DIF:
Cognitive Level: ApplicationREF: p. 68TOP: Nursing Process: Implementation MSC:
NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential

3. Parents ask the nurse why an over-the-counter cough suppressant with sedative side
effects is not recommended for infants. Which response by the nurse is correct?
a. "Babies have a more rapid gastric emptying time and do not absorb drugs well."
b. "Cough medicine tastes bad, and infants usually won't take it."
c. "Infants are more susceptible to central nervous system effects than are adults."
d. "Infants metabolize drugs too rapidly, so drugs are not as effective." - ansANS: C
Drugs cross the blood-brain barrier more readily in infants, making these patients more
susceptible to central nervous system (CNS) side effects. Infants have a prolonged and
irregular gastric emptying time and absorb drugs in the stomach more quickly. Although
it may be true that cough medicines taste bad and are difficult to administer, this is not a
contraindication to giving them. Infants metabolize drugs more slowly.DIF: Cognitive
Level: AnalysisREF: p. 66TOP: Nursing Process: Implementation MSC: NCLEX Client
Needs Category: Physiologic Integrity: Reduction of Risk Potential

4. A nurse caring for a 5-year-old child notes that the child has discoloration of several
teeth. When taking a medication history, the nurse will ask about which group of
medications?
a. Glucocorticoids
b. Salicylates
c. Sulfonamides
d. Tetracyclines - ansANS: D
Tetracyclines cause discoloration in developing teeth in children. Glucocorticoids are
associated with growth suppression. Salicylates are associated with Reye syndrome.
Sulfonamides are associated with kernicterus in newborns.DIF: Cognitive Level:
ApplicationREF: p. 67TOP: Nursing Process: Evaluation MSC: NCLEX Client Needs
Category: Physiologic Integrity: Reduction of Risk Potential

31. A patient reports becoming "immune" to a medication because it no longer works to
alleviate symptoms. The nurse recognizes that this decreased effectiveness is likely
caused by:
a. antagonists produced by the body that compete with the drug for receptor sites.
b. decreased selectivity of receptor sites, resulting in a variety of effects.
c. desensitization of receptor sites by continual exposure to the drug.
d. synthesis of more receptor sites in response to the medication. - ansANS: C
Continual exposure to an agonist would cause the cell to become less responsive or
desensitized. The body does not produce antagonists as a response to a medication.
Receptor site selectivity is determined by physiologic factors and not by the substances
that bind to them. Medications do not cause more receptors to be produced.DIF:

,LEHNE’S PHARMACOTHERAPEUTICS FOR
ADVANCED PRACTICE NURSES AND PHYSICIAN
ASSISTANTS 2ND EDITION ROSENTHAL TEST
BANK.
Cognitive Level: AnalysisREF: p. 32-33TOP: Nursing Process: Diagnosis MSC: NCLEX
Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies

32. A patient who is taking morphine for pain asks the nurse how a pain medication can
also cause constipation. What does the nurse know about morphine?
a. It binds to different types of receptors in the body.
b. It can cause constipation in toxic doses.
c. It causes only one type of response, and the constipation is coincidental.
d. It is selective to receptors that regulate more than one body process. - ansANS: D
Morphine is a medication that is selective to receptor type that regulates more than one
process. Because it is selective to receptor type, it does not bind to different types of
receptors. Constipation is a normal side effect and is not significant for toxicity.DIF:
Cognitive Level: AnalysisREF: p. 35TOP: Nursing Process: Implementation MSC:
NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral
Therapies

33.The nurse is administering morning medications. The nurse gives a patient multiple
medications, two of which compete for plasma albumin receptor sites. As a result of this
concurrent administration, the nurse can anticipate that what might occur?Select all that
apply.
a. Binding of one or both agents will be reduced.
b. Plasma levels of free drug will rise.
c. Plasma levels of free drug will fall.
d. The increase in free drug will intensify effects.
e. The increase in bound drug will intensify effects - ansANS: A,B,D
When two drugs bind to the same site on plasma albumin, co administration of those
drugs produces competition for binding. As a result, binding of one or both agents is
reduced, causing plasma levels of free drug to rise. The increase in free drug can
intensify the effect, but it usually undergoes rapid elimination. The increase in plasma
levels of free drug is rarely sustained.DIF: Cognitive Level: AnalysisREF: p. 36TOP:
Nursing Process: Diagnosis MSC: NCLEX Client Needs Category: Physiologic Integrity:
Pharmacologic and Parenteral Therapies

34. When administering medications to infants, it is important to remember which of the
following?
Select all that apply.
a. Breast-feeding infants are more likely to develop toxicity when given lipid-soluble
drugs.
b. Immaturity of renal function in infancy causes infants to excrete drugs less efficiently.
c. Infants have immature livers, which slows drug metabolism.
d. Infants are more sensitive to medications that act on the central nervous system
(CNS).

, LEHNE’S PHARMACOTHERAPEUTICS FOR
ADVANCED PRACTICE NURSES AND PHYSICIAN
ASSISTANTS 2ND EDITION ROSENTHAL TEST
BANK.
e. Oral medications are contraindicated in infants, because PO administration requires a
cooperative patient. - ansANS: B,C,D
Immature renal function causes infants to excrete drugs more slowly, and infants are at
risk for toxicity until renal function is well developed. Infants' livers are not completely
developed, and they are less able to metabolize drugs efficiently. Because the blood-
brain barrier is not well developed in infants, caution must be used when administering
CNS drugs. Lipid-soluble drugs may be excreted in breast milk if the mother is taking
them, but breastfeeding does not affect medications given directly to the infant. Oral
medications may be given safely to infants as long as they are awake and can swallow
the drug.DIF: Cognitive Level: ComprehensionREF: "pp. 20,22,24"TOP: Nursing
Process: Assessment MSC: NCLEX Client Needs Category: Physiologic Integrity:
Reduction of Risk Potential

36. A nurse is preparing to administer a drug. Upon reading the medication guide, the
nurse notes that the drug has been linked to symptoms of Parkinson disease in some
patients. What will the nurse do?
a. Ask the patient to report these symptoms, which are known to be teratogenic effects.
b. Observe the patient closely for such symptoms and prepare to treat them if needed.
c. Request an order to evaluate the patient's genetic predisposition to this effect.
d. Warn the patient about these effects and provide reassurance that this is expected. -
ansANS: B
A drug that causes disease-like symptoms is known to be iatrogenic. Nurses should be
prepared for this possibility and be prepared to withdraw the drug if necessary and treat
the symptoms. Such effects are not teratogenic, since teratogenic effects affect the
fetus. Patients with a genetic predisposition to respond differently to drugs are known to
have idiosyncratic effects. Iatrogenic effects, even when known, are not typically
expected side effects.DIF: Cognitive Level: ApplicationREF: pp. 41-42TOP: Nursing
Process: Diagnosis MSC: NCLEX Client Needs Category: Physiologic Integrity:
Pharmacologic and Parenteral Therapies

37. Which patients are at increased risk for adverse drug events? Select all that apply.
a. A 2-month-old infant taking a medication for gastroesophageal reflux disease
b. A 23-year-old female taking an antibiotic for the first time
c. A 40-year-old male who is intubated in the intensive care unit and taking antibiotics
and cardiac medications
d. A 7-year-old female receiving insulin for diabetes
e. An 80-year-old male taking medications for COPD - ansANS: A,C,E
Patients at increased risk for adverse drug events include the very young, the very old,
and those who have serious illnesses. Females, children, and young adults taking
single medications do not have increased risk for adverse events.DIF: Cognitive Level:
AnalysisREF: "pp. 42,46"TOP: Nursing Process: Assessment MSC: NCLEX Client
Needs Category: Physiologic Integrity: Reduction of Risk Potential

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