Basic Pharmacology for Nurses 16th Ed by Clayton – Willihnganz – Test Bank

Complete Test Bank With Answers

 

 

 

Sample Questions Posted Below

 

 

 

 

Chapter 5: Patient Education to Promote Health

Test Bank

 

MULTIPLE CHOICE

 

1. The nurse is educating a 13-year-old boy newly diagnosed with diabetes and his parents about diet and glucose monitoring. Which domain of learning is represented when the patient expresses concern about feeling different from his peers?

a.	Cognitive
b.	Psychomotor
c.	Affective
d.	Learning style

 

 

ANS:  C

The affective domain is characterized by conduct that expresses feelings, needs, beliefs, values, and opinions. The cognitive domain relates to basic factual knowledge. The psychomotor domain relates to kinesthetic knowledge, implemented in performance and skills requiring coordination. Learning style is not one of the three domains of learning.

 

DIF:    Cognitive Level: Comprehension     REF:   p. 48               OBJ:   1

TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Safe, Effective Care Environment

 

2. The nurse has taught a patient’s spouse to administer an injectable medication. After the spouse completed a return demonstration of the injection in the hospital, the nurse does not feel confident that this can be carried out independently at home and requests referral for a home health nurse. The nurse is using which phase of the nursing process?

a.	Assessment
b.	Implementation
c.	Planning
d.	Evaluation

 

 

ANS:  D

The nurse has evaluated the injection technique of the patient’s spouse and determines additional instruction is needed. The nurse is not assessing the situation because she is not at the beginning of the process. The nurse is past implementation in the timeline of the process. The nurse has already planned and implemented interventions.

 

DIF:    Cognitive Level: Application           REF:   p. 46               OBJ:   6

TOP:   Nursing Process Step: Evaluation

MSC:  NCLEX Client Needs Category: Safe, Effective Care Environment

 

3. In preparing for health teaching with a patient who has an auditory learning style, which would be most appropriate?

a.	Pamphlets from a pharmaceutical company
b.	Models of equipment used in a procedure
c.	Verbal description of the steps of a procedure
d.	A workbook with space to record actions and results

 

 

ANS:  C

Hearing the nurse present the information optimizes the patient’s perception of the data. Pamphlets from a pharmaceutical company or a workbook would be suitable for a patient who has a visual learning style. Models of equipment would be suitable for a patient with a psychomotor learning style.

 

DIF:    Cognitive Level: Analysis                REF:   p. 49 | p. 53     OBJ:   3

TOP:   Nursing Process Step: Evaluation

MSC:  NCLEX Client Needs Category: Safe, Effective Care Environment

 

4. Which is the most intangible portion of the learning process?

a.	Cognitive
b.	Affective
c.	Psychomotor
d.	Eminent

 

 

ANS:  B

The affective domain concerns feelings, needs, beliefs, values, and opinions. The cognitive domain is the level at which basic knowledge is learned and stored; it is the thinking portion of the learning process. The psychomotor domain involves learning new procedures or skills; it is often referred to as the “doing domain.” Eminent domain in common law legal systems is the lawful power of the state to expropriate private property without the owner’s consent, either for its own use or on behalf of a third party.

 

DIF:    Cognitive Level: Knowledge            REF:   p. 48               OBJ:   1

TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity

 

5. Which would positively affect readiness to learn?

a.	Fear and denial
b.	Willingness to attain an optimal level of health
c.	Poor cognitive and motor development
d.	Lack of trust and confidence in the staff

 

 

ANS:  B

Readiness or the ability to engage in learning depends on motive, relevant preparatory learning, and physiologic maturation. In fear and denial, the patient is neither prepared nor willing to accept the limitations imposed by the disease process and learn to manage lifestyle changes. Poor cognitive and motor development handicap the patient’s willingness and ability to learn. Trust is essential in the process of patient education. The patient must have confidence in the staff in order to be receptive to teaching efforts.

 

DIF:    Cognitive Level: Comprehension     REF:   p. 50               OBJ:   2

TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity

 

6. Which represents the psychomotor domain of learning?

a.	The patient draws up insulin in a syringe.
b.	The patient expresses a belief about medication use.
c.	The patient is able to verbalize foods that should be avoided.
d.	The patient relates past experience with smoking cessation.

 

 

ANS:  A

The psychomotor domain involves the learning of a new procedure and is usually done by demonstration of the task. The patient expressing beliefs is an example of the affective domain. The patient verbalizing foods to be avoided is an example of the cognitive domain. The patient relating past experiences is an example of the affective domain.

 

DIF:    Cognitive Level: Comprehension     REF:   pp. 48-49        OBJ:   1

TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity

 

7. Which is an example of ethnocentrism?

a.	A 5-year-old Native American child colors in a book about diabetes.
b.	A 14-year-old African American attends a support group to learn about disease management.
c.	A 36-year-old Asian prefers to take herbs instead of an oral medication.
d.	A 72-year-old Hispanic asks questions about potential adverse effects to a newly prescribed medication.

 

 

ANS:  C

Ethnocentrism is the assumption that one’s culture provides the right way, and taking herbs instead of the medication exemplifies this belief. A 5-year-old Native American child coloring in a book about diabetes is an example of age appropriate learning process. A 14-year-old African American attending a support group to learn about disease management is an example of developmental impact on learning. A 72-year-old Hispanic person asking questions about potential adverse effects to a newly prescribed medication is demonstrating learning readiness.

 

DIF:    Cognitive Level: Comprehension     REF:   p. 53               OBJ:   4

TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity

 

8. What is the most important nursing consideration when teaching an older adult patient about a newly prescribed medication?

a.	Provide detailed information.
b.	Lengthen the time of each teaching session.
c.	Present information slowly.
d.	Limit discussion on the necessity of learning the information.

 

 

ANS:  C

When teaching older adults, it is important to slow the pace of the presentation. Older adults process information more slowly because of limited short term memory. Detailed information may be too overwhelming. The length of sessions should be limited for the older adult patient. Adults need to understand why they must learn something before they undertake the effort to learn.

 

DIF:    Cognitive Level: Comprehension     REF:   p. 52               OBJ:   6

TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity

 

9. The nurse caring for a Spanish speaking patient uses the assistance of an interpreter to help with preoperative teaching. While implementing the education, the nurse should:

a.	look directly at the patient.
b.	never use pantomime gestures.
c.	ask lengthy questions to provide clarity.
d.	ask a family member to assist with interpretation.

 

 

ANS:  A

When using an interpreter, the nurse should look directly at the patient, not at the interpreter, while conversing. Sometimes supplementing questions with pictures and pantomime gestures may be helpful. The nurse should keep questions brief, asking them one at a time to give the interpreter an opportunity to rephrase the question and obtain a response. Whenever a third person enters into the communication cycle, lack of clarity and misinterpretation can occur.

 

DIF:    Cognitive Level: Application           REF:   p. 53               OBJ:   2

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Psychological Integrity

 

10. A teaching plan has been developed by the nurse to educate the mother of a pre term infant on prescribed medications. Before initiating this teaching plan, the nurse should:

a.	recognize the individual’s health beliefs.
b.	provide a formal learning setting.
c.	ensure that information is generalized.
d.	be sure that all care to the patient has been delivered.

 

 

ANS:  A

Before initiating a teaching plan, the nurse must recognize the individual’s health beliefs. Teaching does not require a formal setting. Because health teaching requires the integration of the patient’s beliefs, attitudes, values, opinions, and needs, an individualized teaching plan must be developed or a standardized teaching plan must be adapted to the individual’s beliefs and needs. Some of the most effective teaching can be done while care is being delivered.

 

DIF:    Cognitive Level: Application           REF:   p. 50               OBJ:   3

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Psychosocial Integrity

 

MULTIPLE RESPONSE

 

11. Which item(s) would be considered characteristic of the cognitive domain level of learning? (Select all that apply.)

a.	A patient’s opinion regarding wellness
b.	Basic mathematical formulas learned in grade school
c.	Incorporation of a person’s previous experiences and perceptions
d.	Skill demonstration using a step by step approach
e.	Relationship between prior experiences and new concepts

 

 

ANS:  B, C, E

Basic mathematical formulas learned previously, incorporating a person’s previous experiences and perceptions, and a relationship between prior experiences and new concepts characterize the cognitive domain level of learning. A patient’s opinion regarding wellness is an example of the affective domain. Skill demonstration using a step by step approach is an example of the psychomotor domain.

 

DIF:    Cognitive Level: Comprehension     REF:   p. 48               OBJ:   1

TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Safe, Effective Care Environment

 

12. The nurse is preparing to instruct a patient and his wife on technique and importance of assessing pulse prior to taking heart medication. Which principle(s) of learning would be appropriate in this situation? (Select all that apply.)

a.	The learning environment
b.	The patient’s and wife’s learning styles
c.	The objectives/goal statements listed on the patient’s care plan
d.	The patient’s financial ability to purchase the medication
e.	The patient’s understanding of the seriousness of his illness

 

 

ANS:  A, B, C, E

Learning environment, learning style, listing clear objectives and goal statements, and understanding the seriousness of the situation are all principles of learning. Financial ability is not a principle of learning, but should be an important consideration and assessment when preparing for discharge of the patient and future compliance of the treatment regimen.

 

DIF:    Cognitive Level: Application           REF:   p. 49               OBJ:   3

TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity

 

13. The nurse is writing a teaching plan for a 30-year-old patient who has AIDS. Which objective(s) is/are written in the correct format? (Select all that apply.)

a.	The patient will state adverse effects of the daily medications before discharge.
b.	The patient will correctly fill the daily medication pillbox with the correct medications in the appropriate time slots prior to discharge.
c.	The patient will adjust the medications accordingly.
d.	The patient will schedule an appointment with the infectious disease physician before discharge.
e.	The patient will have lab tests performed regularly.

 

 

ANS:  A, B, D

Each of correct objectives noted are measurable and specific.

 

DIF:    Cognitive Level: Analysis                REF:   p. 55               OBJ:   6

TOP:   Nursing Process Step: Planning

MSC:  NCLEX Client Needs Category: Physiological Integrity

 

14. Which action(s) by the nurse can foster patient responsibility for adhering to the therapeutic regimen? (Select all that apply.)

a.	Assessing the patient’s readiness to learn
b.	Determining the patient’s level of understanding of content
c.	Determining the patient’s education level and learning style
d.	Maintaining an aloof attitude toward presented content
e.	Documenting expected outcomes independently

 

 

ANS:  A, B, C

The nurse should assess the patient’s readiness to learn when teaching the patient. The nurse should determine the patient’s level of understanding of the content and the patient’s education level and learning style when teaching the patient. The nurse should portray a positive attitude when teaching the patient. Goals should be mutually written with the patient.

 

DIF:    Cognitive Level: Comprehension     REF:   p. 55               OBJ:   4

TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Safe, Effective Care Environment

 

15. What should the nurse include during discharge in addition to verbal instructions? (Select all that apply.)

a.	Written instructions for the patient’s reference
b.	A phone number of the provider or hospital unit for follow up questions
c.	Written instructions for monitoring of parameters used to evaluate therapy
d.	Documentation in the nurse’s discharge notes of the nursing and collaborative problems that require continued monitoring and intervention
e.	Identification of the patient’s unreasonable expectations of therapy

 

 

ANS:  A, B, C, D

Learning is an ongoing process. Verbal instructions should be followed up with instructions in writing. Patients should be given a contact number for future reference. Written instructions for monitoring of parameters used to evaluate therapy should be given to the patient. Documentation is an essential part of validating the patient’s understanding of the instructions provided. Although identifying the patient’s expectations will affect the outcome, they are not part of the discharge planning documentation.

 

DIF:    Cognitive Level: Application           REF:   p. 49               OBJ:   5 | 6

TOP:   Nursing Process Step: Evaluation

MSC:  NCLEX Client Needs Category: Safe, Effective Care Environment

 

16. Which action(s) would let the nurse know that the patient has mastered a psychomotor skill? (Select all that apply.)

a.	Describe the process verbally.
b.	Write a description of the process.
c.	Give a reciprocal demonstration of the process.
d.	Ask questions about the process.
e.	Demonstrate the process to another person while the nurse supervises.
f.	State whether the patient feels the process has been mastered.

 

 

ANS:  C, D

Having the patient demonstrate the process to the nurse or to another person is the best way to ensure that he can perform the skill correctly. Having the patient describe the process or write a description of the process is not sufficient. Asking questions may reinforce learning but may also mask some deficiencies. Asking the patient whether he feels he has mastered the process is not sufficient.

 

DIF:    Cognitive Level: Comprehension     REF:   p. 50               OBJ:   6

TOP:   Nursing Process Step: Evaluation

MSC:  NCLEX Client Needs Category: Physiological Integrity

 

17. The nurse and patient are participating in cooperative goal setting regarding drug therapy. The nurse is aware that it is imperative to encourage the patient to perform which task(s)? (Select all that apply.)

a.	Contact the hospital for advice regarding discontinuation of medication.
b.	Keep records of essential data needed to evaluate prescribed therapy.
c.	See the health care provider regularly.
d.	Avoid community based agencies for assistance.
e.	Monitor parameters used to evaluate therapy.

 

 

ANS:  B, C, E

An attitude of shared input into the goals and outcomes can encourage the patient into a therapeutic alliance. Therefore, the patient should be taught to help monitor the parameters used to evaluate therapy, keep records of essential data, and contact the health care provider for advice rather than alter or discontinue the medication entirely. The health care provider, not the hospital, should be contacted. In the event that the patient, family, or significant others do not understand all aspects of the continuing therapy prescribed, they may be referred to a community based agency for help in achieving long term health care requirements.

 

DIF:    Cognitive Level: Application           REF:   p. 56               OBJ:   3

TOP:   Nursing Process Step: Planning

MSC:  NCLEX Client Needs Category: Safe, Effective Care Environment

 

 

 

 

Chapter 35: Drugs Used to Treat Constipation and Diarrhea

Test Bank

 

MULTIPLE CHOICE

 

1. When the nurse assesses bowel habits in a patient, which is the best example of normal bowel elimination?

a.	Daily bowel movements
b.	Multiple soft stools daily
c.	Daily liquid stools
d.	Regular bowel elimination pattern of soft stool

 

 

ANS:  D

Normal bowel habits are stools that are soft and occur on a regular schedule of elimination for that particular patient. Although this may be routine for some people, it is not normal for everyone. Liquid stools are not considered normal.

 

DIF:    Cognitive Level: Comprehension     REF:   p. 551             OBJ:   1

TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity

 

2. Which drug would be most effective for an obstetric patient who is complaining of constipation as a result of her enlarging uterus and use of prenatal vitamins?

a.	Saline laxative
b.	Lubricant laxative
c.	Stimulant laxative
d.	Mineral oil

 

 

ANS:  B

Lubricant and bulk forming laxatives may be used in the pregnant patient because little cramping accompanies their use. Saline laxatives are not safe for a pregnant woman because of the bowel distention and possible electrolyte imbalance they may cause. Stimulant laxatives are too harsh for a pregnant woman because they may cause cramping. Mineral oil is not a good laxative to use on a regular basis because it can cause malabsorption of vitamins.

 

DIF:    Cognitive Level: Application           REF:   p. 555             OBJ:   2

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Physiological Integrity

 

3. The nurse is performing a premedication assessment. For which patient would laxative use be contraindicated?

a.	Patient with quadriplegia
b.	Patient with appendicitis
c.	Geriatric patient
d.	Patient with fractured femur

 

 

ANS:  B

Patients who have a history of an inflammation of the gastrointestinal (GI) tract, including gastritis, colitis, Crohn’s disease, ulcerative colitis, and appendicitis, should not take laxatives and should be referred to a health care provider. Quadriplegic and geriatric patients as well as patients with fractures may generally take laxatives and stool softeners on a regular basis.

 

DIF:    Cognitive Level: Application           REF:   p. 552 | p. 555

OBJ:   2                    TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity

 

4. Which is the laxative of choice for an older patient who is in the end stage of Alzheimer’s disease and requires a daily laxative?

a.	Emollient
b.	Stimulant
c.	Fecal softener
d.	Bulk forming

 

 

ANS:  D

Bulk forming laxatives are considered the safest laxative for routine use because they cause water to be retained within the stool, which increases bulk, and stimulates peristalsis. Emollient laxatives reduce muscle tone and decrease peristalsis over time. Stimulant laxatives can cause cramping and should not be used on a regular basis. Fecal softeners are not laxatives.

 

DIF:    Cognitive Level: Analysis                REF:   p. 555             OBJ:   2

TOP:   Nursing Process Step: Evaluation

MSC:  NCLEX Client Needs Category: Health Promotion and Maintenance

 

5. A friend reports using loperamide (Imodium) for continual diarrhea for a week since returning home from a vacation outside the country. Which is the nurse’s best response?

a.	“There are some other over the counter products available for diarrhea, such as Kaopectate (bismuth subsalicylate).”
b.	“I’d stop taking the Imodium and go in to see a health care provider immediately. You may have an infection in your intestinal tract.”
c.	“If you’re not running a temperature, I wouldn’t worry. That happens to many people when they travel.”
d.	“As long as you can drink plenty of fluids, I’m sure the diarrhea will go away once you’re back in a normal routine.”

 

 

ANS:  B

Diarrhea may be a defense mechanism to rid the body of infecting organisms or irritants. Diarrhea is usually self limiting and should not be suppressed with over the counter products. It is safest for people who are suffering from diarrhea after traveling outside the country to visit their health care provider, who can determine whether an infection is present.

 

DIF:    Cognitive Level: Application           REF:   pp. 551-552    OBJ:   6

TOP:   Nursing Process Step: Evaluation

MSC:  NCLEX Client Needs Category: Health Promotion and Maintenance

 

6. A patient who has had a myocardial infarction is advised to avoid straining with defecation. Which medication would be prescribed to this patient?

a.	Stool softeners
b.	Bulk forming laxatives
c.	Stimulants
d.	Emollients

 

 

ANS:  A

Stool softeners are routinely used for the prevention of constipation or to prevent straining with defecation (e.g., in patients recovering from myocardial infarction or abdominal surgery). Bulk forming laxatives and emollients can cause straining. Stimulants can cause cramping and straining.

 

DIF:    Cognitive Level: Analysis                REF:   p. 555             OBJ:   2

TOP:   Nursing Process Step: Evaluation

MSC:  NCLEX Client Needs Category: Health Promotion and Maintenance

 

7. An older adult is admitted through the emergency department with complaints of nausea, abdominal tenderness, and continual stooling. On assessment, the nurse notes abdominal distention, smearing of stool on undergarments, and hypoactive bowel sounds LUQ and LLQ. The patient is unable to determine when the last bowel movement was. What is the nurse’s priority assessment?

a.	Signs and symptoms of an infection
b.	An impaction
c.	A pattern of laxative abuse
d.	History of GI disease

 

 

ANS:  B

A nursing priority is to determine basic needs such as last bowel movement, constipation, and pain control. The symptoms presented do not indicate an infection as a priority. Frequent stooling indicated by the history and smearing on the undergarments is a sign of an impaction, or an area of hardened stool. Laxative abuse or a history of GI disease may be contributing factors that the health care provider will review. Although the patient may have an infection or history of GI disease, checking for an impaction is a higher priority because it is done more quickly and is more likely to yield results. These symptoms are not characteristic of laxative abuse.

 

DIF:    Cognitive Level: Application           REF:   p. 556             OBJ:   1

TOP:   Nursing Process Step: Evaluation

MSC:  NCLEX Client Needs Category: Health Promotion and Maintenance

 

8. Which symptom is the patient with a lactase deficiency most likely to exhibit?

a.	Constipation
b.	Excessive salivation
c.	Diarrhea
d.	Vomiting

 

 

ANS:  C

Patients with deficiencies of digestive enzymes such as lactase or amylase have difficulty digesting certain foods. Diarrhea usually develops because of irritation from undigested food. Constipation, excessive salivation, and vomiting do not result from enzyme deficiencies.

 

DIF:    Cognitive Level: Comprehension     REF:   p. 552             OBJ:   3

TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity

 

9. A patient is receiving morphine for pain control. What will the nurse emphasize about preventing constipation?

a.	Adequate hydration consists of four full glasses of water every day.
b.	Laxatives should be given on a daily basis.
c.	Stool softeners are taken on a regular basis during opioid use.
d.	Enemas should be given on a weekly basis.

 

 

ANS:  C

When codeine or morphine is used regularly for pain control in cancer patients, it is imperative that the individual know that stool softeners should be initiated and continued as long as constipating medicines are being taken. Although adequate hydration is important in the prevention of constipation, individual needs vary, and hydration alone cannot prevent constipation related to opioid use. Laxatives are too harsh to be given regularly unless specifically ordered by the health care provider. Enemas are not a preventive measure but an intervention intended to produce a more positive outcome.

 

DIF:    Cognitive Level: Application           REF:   p. 554             OBJ:   1

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Physiological Integrity

 

10. What is the mechanism of action of a stimulant laxative?

a.	Draws water into the bowel to facilitate the passage of feces
b.	Lubricates the intestinal wall and soften stool
c.	Increases bulk and stimulate peristalsis
d.	Irritates the intestine directly, promoting peristalsis and evacuation

 

 

ANS:  D

Stimulant laxatives act directly on the intestine, causing an irritation that promotes peristalsis and evacuation. Saline laxatives draw water into the bowel to facilitate the passage of feces. Lubricant laxatives lubricate the intestinal wall and soften the stool, allowing a smooth passage of fecal contents. Bulk producing laxatives must be administered with a full glass of water. The laxative causes water to be retained within the stool. This increases bulk, which stimulates peristalsis.

 

DIF:    Cognitive Level: Comprehension     REF:   p. 554             OBJ:   2

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Physiological Integrity

 

11. Which effect will the nurse expect when a patient is taking psyllium while on digoxin?

a.	Decreased effectiveness of the laxative
b.	Increased laxative effect
c.	Increased absorption of the digoxin
d.	Decreased absorption of the digoxin

 

 

ANS:  D

Do not administer products containing psyllium (e.g., Metamucil) at the same time as salicylates, nitrofurantoin, or digoxin glycosides. The psyllium may inhibit absorption. Administer these medications at least 1 hour before or 2 hours after psyllium. Digoxin does not affect laxatives.

 

DIF:    Cognitive Level: Comprehension     REF:   p. 556             OBJ:   2

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Physiological Integrity

 

12. Which instruction will the nurse include in the discharge teaching of a patient taking psyllium?

a.	“Administer with a full glass of water.”
b.	“Limit the intake of high fiber foods.”
c.	“Avoid mixing in juice.”
d.	“Fat soluble vitamin deficiency is common.”

 

 

ANS:  A

It is important that bulk forming laxatives be dispersed in a full glass of water or juice before administration. High fiber foods should not be limited. Psyllium may be mixed in juice for administration. Fat soluble vitamin deficiency is not a common adverse effect.

 

DIF:    Cognitive Level: Application           REF:   p. 555             OBJ:   2

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Physiological Integrity

 

13. Which instruction by the nurse will assist in the patient’s understanding of lactulose, an osmotic laxative?

a.	“This medication draws water into the intestine and stimulates defecation.”
b.	“There is increased irritability directly on the intestinal wall.”
c.	“There is lubrication of the intestinal wall that softens the stool.”
d.	“There is an effect on the nerves to increase the peristalsis of the intestinal smooth muscle.”

 

 

ANS:  A

Osmotic laxatives (e.g., magnesium hydroxide, magnesium sulfate, magnesium citrate, sodium phosphate, lactulose, polyethylene glycol) are hypertonic compounds that draw water into the intestine from surrounding tissues.

 

DIF:    Cognitive Level: Application           REF:   p. 555             OBJ:   2

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Physiological Integrity

 

14. The nurse is caring for a patient receiving palliative care with opioid induced constipation. Laxative therapy has been unsuccessful in treating this patient. Which PRN medication should the nurse provide to best alleviate this type of constipation?

a.	Methylnaltrexone
b.	Bisacodyl
c.	Mineral oil
d.	Docusate

 

 

ANS:  A

Methylnaltrexone is used for the treatment of opioid induced constipation in patients with advanced illness who are receiving palliative care when their response to laxative therapy has not been adequate. Bisacodyl, mineral oil, and docusate are not the treatment of choice for this situation.

 

DIF:    Cognitive Level: Application           REF:   p. 555             OBJ:   2

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Physiological Integrity

 

15. The nurse is assessing a patient taking lactulose to treat chronic constipation. Which adverse effect should the nurse immediately report to the health care provider?

a.	Nausea
b.	Abdominal spasms
c.	Flatulence
d.	Abdominal tenderness

 

 

ANS:  D

Abdominal tenderness is considered a serious adverse effect and can indicate acute abdomen. Nausea, abdominal spasms, and flatulence is a common adverse effect.

 

DIF:    Cognitive Level: Analysis                REF:   p. 556             OBJ:   2

TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity

 

MULTIPLE RESPONSE

 

16. The nurse is assessing a patient with constipation. Which situation(s) would cause constipation? (Select all that apply.)

a.	Diet low in fiber and/or residue
b.	Excessive fluid intake
c.	Diet low in cheese and yogurt
d.	Iron supplements
e.	Use of morphine

 

 

ANS:  A, D, E

Constipation can be caused by diets lacking in adequate residue and/or fiber and fluids or the use of constipating medicines (morphine, codeine, anticholinergic agents). Iron has a constipating effect. Fluid intake helps prevent constipation. Constipation can be caused by excessive intake of constipating foods such as cheese or yogurt.

 

DIF:    Cognitive Level: Comprehension     REF:   p. 551             OBJ:   1

TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity

 

17. Which sign(s) and symptom(s) are consistent with dehydration? (Select all that apply.)

a.	Increased hemoglobin and hematocrit
b.	Decreased urine specific gravity
c.	Mental confusion and excessive thirst
d.	Periorbital edema and increased blood pressure
e.	Nonelastic skin turgor and delayed capillary filling

 

 

ANS:  A, C, E

Blood work of dehydrated patients will show falsely elevated hemoglobin and hematocrit levels as a result of decreased capillary fluid. Dehydrated patients may become confused as a result of electrolyte imbalances and often complain of thirst. Older patients may not complain of thirst as a result of perceptual changes. Dehydration is evident by nonelastic skin turgor and delayed capillary filling.

 

DIF:    Cognitive Level: Analysis                REF:   p. 553             OBJ:   5

TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Health Promotion and Maintenance

 

18. Which treatment(s) would be considered safe for an infant? (Select all that apply.)

a.	Saline laxatives
b.	Bulk forming laxatives
c.	Malt soup extract
d.	Stimulant laxatives

 

 

ANS:  B, C

Constipation in infants can be treated with a bulk forming laxative and malt soup extract. Saline laxatives are not appropriate for infants because of the risk of electrolyte imbalances. Stimulant laxatives are not appropriate for infants.

 

DIF:    Cognitive Level: Analysis                REF:   p. 555             OBJ:   2

TOP:   Nursing Process Step: Evaluation

MSC:  NCLEX Client Needs Category: Health Promotion and Maintenance

 

19. The nurse in a long term care facility is preparing to pass medications to the residents. To which of the following residents should the nurse administer an antidiarrheal? (Select all that apply.)

a.	An 80-year-old woman with diarrhea of sudden onset that has lasted 3 days
b.	A 76-year-old man with infectious diarrhea
c.	A 92-year-old man with diarrhea secondary to inflammatory bowel disease
d.	A 70-year-old woman with a history chronic diarrhea from GI surgery
e.	An 88-year-old man that has had two episodes of stress induced diarrhea

 

 

ANS:  A, C, D

Diarrhea of sudden onset lasting more than 2 or 3 days can cause significant fluid and water loss; therefore, an antidiarrheal is indicated. Patients with inflammatory bowel disease develop diarrhea. Rapid treatment shortens the course of the incapacitating diarrhea and allows the patient to live a more normal lifestyle. Postoperative GI surgery patients develop diarrhea. These patients may require chronic antidiarrheal therapy to allow adequate absorption of fluids and electrolytes. Antidiarrheals should not be given to patients known to have infectious diarrhea. Two bouts of diarrhea would not indicate a need for an antidiarrheal.

 

DIF:    Cognitive Level: Analysis                REF:   p. 553 | p. 557

OBJ:   6                    TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity