Basic Pharmacology for Nursing 17th Edition by Michelle Willihnganz – Test Bank

Complete Test Bank With Answers

 

 

 

Sample Questions Posted Below

 

 

 

 

 

Chapter 05: Patient Education to Promote Health

Clayton/Willihnganz: Basic Pharmacology for Nurses, 17th Edition

 

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:   Page 49          OBJ:   1

TOP:   Nursing Process Step: Assessment

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

NOT:  CONCEPT(S): Patient Education; Health Promotion

 

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:   Page 51          OBJ:   5 | 6

TOP:   Nursing Process Step: Evaluation

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

NOT:  CONCEPT(S): Clinical Judgment; Safety; Patient Education; Health Promotion; Care Coordination

 

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:   Page 50          OBJ:   1 | 2 | 6

TOP:   Nursing Process Step: Evaluation

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

NOT:  CONCEPT(S): Clinical Judgment; Patient Education; Communication

 

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:   Page 49          OBJ:   1

TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Patient Education

 

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:   Page 51          OBJ:   2

TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Patient Education

 

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:   Page 50          OBJ:   1

TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Patient Education

 

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 an 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:   Page 54          OBJ:   2

TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Patient Education

 

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:   Page 53          OBJ:   6

TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Patient Education; Communication

 

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:   Page 54          OBJ:   2 | 4 | 6

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Psychological Integrity

NOT:  CONCEPT(S): Health Promotion; Patient Education; Communication

 

10. A teaching plan has been developed by the nurse to educate the mother of a preterm 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:   Page 51          OBJ:   3 | 4

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Psychosocial Integrity

NOT:  CONCEPT(S): Clinical Judgment; Safety; Patient Education; Communication; Health Promotion

 

MULTIPLE RESPONSE

 

1. 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:   Page 49          OBJ:   1

TOP:   Nursing Process Step: Assessment

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

NOT:  CONCEPT(S): Patient Education; Communication

 

2. 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:   Page 50 | Page 51

OBJ:   3 | 4                TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Patient Education; Communication; Health Promotion

 

3. 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:   Page 56 | Page 57

OBJ:   3 | 4 | 6            TOP:   Nursing Process Step: Planning

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Patient Education

 

4. 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:   Page 56          OBJ:   4

TOP:   Nursing Process Step: Assessment

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

NOT:  CONCEPT(S): Clinical Judgment; Patient Education; Care Coordination; Communication; Health Promotion

 

5. 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:   Page 50          OBJ:   5 | 6

TOP:   Nursing Process Step: Evaluation

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

NOT:  CONCEPT(S): Clinical Judgment; Patient Education; Care Coordination; Communication; Health Promotion

 

6. 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:   Page 51          OBJ:   1 | 6

TOP:   Nursing Process Step: Evaluation

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Patient Education; Care Coordination; Communication; Health Promotion

 

7. 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:   Page 57          OBJ:   3 | 4

TOP:   Nursing Process Step: Planning

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

NOT:  CONCEPT(S): Clinical Judgment; Patient Education; Care Coordination; Communication; Health Promotion

 

 

 

 

Chapter 31: Drugs Used to Treat Oral Disorders

Clayton/Willihnganz: Basic Pharmacology for Nurses, 17th Edition

 

MULTIPLE CHOICE

 

1. A patient with chronic obstructive pulmonary disease (COPD) uses a corticosteroid inhaler bid. Which adverse effect is associated with this medication?

a.	Mucositis
b.	Plaque
c.	Xerostomia
d.	Candidiasis

 

 

ANS:  D

Medications that predispose a patient to candidiasis are those that suppress the immune system, including immunosuppressants, corticosteroids, cytotoxics, and broad spectrum antibiotics. Educating patients on the importance of oral hygiene following prescribed inhalation dosages will assist in decreasing this complication. Mucositis, plaque, and xerostomia are not associated with steroid inhaler use.

 

DIF:    Cognitive Level: Application           REF:   Page 485        OBJ:   1

TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Safety; Infection

 

2. The nurse is assessing a patient’s mouth and notes white, milk curd-appearing plaques attached to the oral mucosa. Which condition is present?

a.	Thrush
b.	Canker sores
c.	Cold sores
d.	Mucositis

 

 

ANS:  A

Thrush is characterized by white, milk curd-appearing plaques that are attached to the oral mucosa. Canker sores can appear as ulcers 0.5 to 2 cm in diameter on surfaces that are not attached to bone, such as the tongue, gums, or inner lining of the cheeks and lips. Cold sores (“fever blisters”) are most commonly found at the junction of the mucous membrane and the skin of the lips or nostrils, although they can occur inside the mouth, especially affecting the gums and roof of the mouth. Mucositis is a general term used to describe a painful inflammation of the mucous membranes of the mouth.

 

DIF:    Cognitive Level: Knowledge            REF:   Page 485        OBJ:   1

TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Health Promotion and Maintenance

NOT:  CONCEPT(S): Clinical Judgment; Infection

 

3. What is the primary pharmacologic therapy for Candida albicans?

a.	Steroids
b.	Antifungal agents
c.	Topical anesthetics
d.	Topical anti-inflammatory agents

 

 

ANS:  B

Candida albicans is the most common oral infection appearing in extremely debilitated patients. Medications that predispose a person to C. albicans infections are those that depress the immune system and those that cause xerostomia. C. albicans is a fungus and therefore is treated with antifungal agents such as nystatin (Mycostatin). Steroids, topical anesthetics, and topical anti-inflammatory agents are not used to treat C. albicans.

 

DIF:    Cognitive Level: Knowledge            REF:   Page 485        OBJ:   1 | 2

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Health Promotion and Maintenance

NOT:  CONCEPT(S): Clinical Judgment; Infection

 

4. Which condition is treated by saliva substitutes?

a.	Caries
b.	Mucositis
c.	Xerostomia
d.	Halitosis

 

 

ANS:  C

Xerostomia, or lack of saliva, originates from nonoral causes. Xerostomia is treated by discontinuing medications that dry the mucous membranes or by artificial saliva products. Dentifrices are used to treat caries. Saliva substitutes are not used to treat mucositis. Mouthwash is used to treat halitosis, along with dentifrices.

 

DIF:    Cognitive Level: Knowledge            REF:   Page 486        OBJ:   1 | 2

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Health Promotion and Maintenance

NOT:  CONCEPT(S): Clinical Judgment; Nutrition

 

5. Which information will the nurse include when teaching a patient about cold sores?

a.	Use of drying agents prevents the spread of secretions.
b.	Erupted lesions are not contagious.
c.	Eruptions are related to breaks in personal hygiene.
d.	Pus-filled lesions indicate a secondary bacterial infection.

 

 

ANS:  D

Cold sore lesions first become visible as small red papules that later develop into 1- to 3-mm diameter fluid-filled blisters. Over the following 10 to 14 days, a crust develops as the vesicles that burst coalesce into larger lesions. The liquid from the vesicles contains the live virus that can be transferred to other people by direct contact. The base of the lesions is erythematous. If pus develops in the vesicles or under the crust of a cold sore, a secondary bacterial infection may be present and the patient should seek medical attention. Drying agents are not used to treat cold sores. Cold sores are contagious. Eruptions are not necessarily related to poor personal hygiene.

 

DIF:    Cognitive Level: Application           REF:   Page 484        OBJ:   1

TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Health Promotion and Maintenance

NOT:  CONCEPT(S): Clinical Judgment; Infection

 

6. Which local anesthetic is used for inflammation of oral mucous membranes?

a.	Chlorhexidine (Peridex)
b.	2% viscous lidocaine
c.	Nystatin (Mycostatin)
d.	Hydrogen peroxide

 

 

ANS:  B

Two percent viscous lidocaine is used as a topical anesthetic for pain associated with oral inflammation. Care must be taken so that the patient does not accidentally burn himself or herself because the drug anesthetizes the entire mouth and throat. Chlorhexidine, nystatin, and hydrogen peroxide are not local anesthetics.

 

DIF:    Cognitive Level: Knowledge            REF:   Page 486        OBJ:   1 | 2

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Inflammation

 

7. Which medication helps prevent or reduce mucositis in patients undergoing chemotherapy or radiation treatment?

a.	Amlexanox paste (Aphthasol)
b.	Palifermin (Kepivance)
c.	Docosanol (Abreva)
d.	Nystatin (Mycostatin)

 

 

ANS:  B

Palifermin is a recombinant human keratinocyte growth factor approved specifically for preventing and treating the mucositis that develops in leukemia or lymphoma patients undergoing chemotherapy before bone marrow transplantation. Amlexanox paste is used to treat canker sores. Docosanol is used to treat cold sores. Nystatin is used to treat thrush.

 

DIF:    Cognitive Level: Knowledge            REF:   Page 487        OBJ:   3

TOP:   Nursing Process Step: Planning

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Inflammation; Health Promotion

 

8. Which infection is often called the “disease of the diseased” because it appears in debilitated patients?

a.	Aspergillosis
b.	Candidiasis
c.	Trichomoniasis
d.	Brucellosis

 

 

ANS:  B

Candidiasis is a fungal infection caused by Candida albicans, the most common organism associated with oral infections. It is often called the “disease of the diseased” because it appears in debilitated patients and patients taking a variety of medicines. Aspergillosis is caused by the fungus Aspergillus, which is commonly found growing on dead leaves, stored grain, or compost piles, or in other decaying vegetation. Although it is similar to candidiasis in its occurrence in debilitated patients, it is not as common. Trichomoniasis is a common parasitic sexually transmitted disease. Brucellosis is a zoonotic infection transmitted from animals to humans by the ingestion of infected food products, direct contact with an infected animal, or inhalation of aerosols.

 

DIF:    Cognitive Level: Comprehension     REF:   Page 485        OBJ:   1

TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Infection

 

9. What is the most common cause of most tooth, gum, and periodontal disease?

a.	Sugar
b.	Halitosis
c.	Plaque
d.	Smoking

 

 

ANS:  C

Plaque is the primary cause of most tooth, gum (gingiva), and periodontal disease. Plaque, the whitish yellow substance that builds up on teeth and gum lines, is thought to originate from saliva. Plaque forms a sticky meshwork that traps bacteria and food particles. If not removed regularly, it thickens, and bacteria proliferate. Sugar is not a cause of dental disease as such but becomes a problem when poor oral hygiene allows it to collect in the oral cavity. Halitosis is a symptom of poor oral hygiene but is not a cause of dental disease. Although smoking can contribute to periodontal disease through vasoconstriction, it is not a cause of dental disease.

 

DIF:    Cognitive Level: Comprehension     REF:   Page 487        OBJ:   1

TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Inflammation

 

10. Which instruction by the nurse is most important when educating a patient about using viscous lidocaine (Xylocaine) for mucositis?

a.	“Cleanse the oral cavity after using.”
b.	“This medication can be used as a gargle.”
c.	“After using, wait for 30 minutes before eating.”
d.	“Your sense of taste will be diminished.”

 

 

ANS:  C

Caution the patient not to take food or drink for approximately 30 minutes after the medication because of the risk of aspiration from the absence of the gag reflex. The oral cavity is cleansed before administration. The medication can be used as a gargle and the sense of taste is diminished, but these are not the most important instructions.

 

DIF:    Cognitive Level: Application           REF:   Page 487        OBJ:   2 | 3

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Inflammation; Safety; Patient Education

 

11. A patient is being treated with topical amlexanox paste 5% (Zilactin). Which statement by the patient indicates a knowledge deficit?

a.	“This medicine will help control discomfort.”
b.	“I will apply the paste before meals.”
c.	“The paste will be applied to each lesion.”
d.	“Healing will be promoted.”

 

 

ANS:  B

It is best to apply amlexanox paste 5% (Zilactin) after meals. Discomfort is controlled with this medication; it is applied to each lesion and promotes healing.

 

DIF:    Cognitive Level: Analysis                REF:   Page 486        OBJ:   2 | 3

TOP:   Nursing Process Step: Evaluation

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Safety; Patient Education

 

12. A patient using carbamide peroxide (Gly-Oxide) to treat multiple canker sores develops tissue irritation and black hairy tongue. The patient asks the nurse what can be done to soothe the pain. The nurse will first encourage use of

a.	Milk of Magnesia.
b.	viscous lidocaine 2%.
c.	Salivart.
d.	saline rinses.

 

 

ANS:  D

Saline rinses may be soothing and can be used before topical application of carbamide peroxide (Gly-Oxide). They would be encouraged prior to other measures. Milk of Magnesia, viscous lidocaine 2%, and Salivart are not used to soothe this side effect.

 

DIF:    Cognitive Level: Application           REF:   Page 488        OBJ:   1 | 2

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Inflammation; Patient Education

 

13. The nurse is assisting with care of a patient on chemotherapy with severe mucositis. The patient reports mucous membrane pain level to be “8” on the pain scale. The priority nursing diagnosis for this patient is

a.	altered nutrition: less than body requirements.
b.	risk for aspiration.
c.	fluid volume deficit.
d.	pain.

 

 

ANS:  D

Pain is the nursing priority. A score of “8” indicates severe pain and comfort measures would take priority. Altered nutrition: less than body requirements, risk for aspiration, and fluid volume deficit are not the priorities at this time.

 

DIF:    Cognitive Level: Analysis                REF:   Page 487        OBJ:   3

TOP:   Nursing Process Step: Diagnosis

MSC:  NCLEX Client Needs Category: Safe, Effective Care Environment| NCLEX Client Needs Category: Physiological Integrity         NOT:             CONCEPT(S): Clinical Judgment; Pain

 

MULTIPLE RESPONSE

 

1. The nurse is completing education for a patient who will be undergoing chemotherapy next week. In anticipation of adverse effects associated with oral mucositis resulting from chemotherapy, which information will the nurse include in the teaching plan? (Select all that apply.)

a.	Avoid acidic and spicy foods.
b.	Using docosanol (Abreva) will decrease the pain.
c.	Milk of Magnesia can be used to rinse the mouth and coat mucous membranes.
d.	Nystatin liquid can be taken orally to eliminate fungal infections.
e.	Cleanse the oral cavity before applying topical agents.
f.	Rinse the mouth with an over-the-counter (OTC) mouthwash.

 

 

ANS:  A, C, D, E

Spicy and acidic foods should be avoided to prevent irritation to mucous membranes. Viscous lidocaine 2%, Milk of Magnesia, diluted bismuth subsalicylate (Kaopectate), and sucralfate suspensions may be used for topical application. Oral candidal infections are often adverse effects of chemotherapy, and nystatin liquid, an antifungal agent, may be prescribed. Directions for using this agent include swishing the medication in the oral cavity for approximately 1 minute before swallowing or sucking on lozenges (troches) to reduce candidal oral infections. Pain medication applied topically must come into contact with mucous membranes to be effective. Therefore, it is advisable to clean the oral cavity before application. This medication is not used in the treatment of oral mucositis. OTC mouthwashes are usually not recommended for treatment of mucositis.

 

DIF:    Cognitive Level: Application           REF:   Page 488        OBJ:   1 | 3

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Inflammation; Safety; Patient Education

 

2. What will the nurse include when educating a 12-year-old patient about care of a cold sore? (Select all that apply.)

a.	“Keep the cold sore clean with mild soap.”
b.	“Use an astringent to assist in drying the cold sore and promote rapid healing.”
c.	“Keep the cold sore moist to prevent cracking.”
d.	“Note signs of infection, including the presence of pus. Contact the health care provider if this occurs.”
e.	“Oral analgesics may help alleviate pain.”

 

 

ANS:  A, C, D, E

To reduce the possibility of further infection with bacteria, the area should be kept clean.

Cold sores should be kept moist to prevent cracking and the development of secondary bacterial infection. With secondary infection, application of antibiotic ointment would be indicated. Application of docosanol, local anesthetics, and UV blockers or oral analgesics may be prescribed. Astringents should be avoided to prevent drying, delayed healing, and increased discomfort.

 

DIF:    Cognitive Level: Application           REF:   Page 484 | Page 486

OBJ:   1 | 2                TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Infection; Tissue Integrity; Patient Education

 

3. Which assessment information is pertinent to oral health? (Select all that apply.)

a.	Medication history
b.	Dental history, visit frequency
c.	Presence of halitosis
d.	Amount of saliva present
e.	Bowel sounds

 

 

ANS:  A, B, C, D

Pertinent history for oral health includes current drug therapy and dental history and frequency. Halitosis may indicate poor oral hygiene or the presence of infection in the oral cavity. Reduced amount of saliva is a risk factor for injury and infection in the oral cavity. Bowel sounds are not pertinent information to oral health.

 

DIF:    Cognitive Level: Application           REF:   Page 487        OBJ:   1 | 3

TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Health Promotion

 

4. A patient who is undergoing bone marrow transplantation has developed severe mucositis. Which treatment option(s) may promote comfort? (Select all that apply.)

a.	2% viscous lidocaine (Xylocaine) before meals
b.	Acetylcysteine (Mucomyst) therapy as needed
c.	Commercially prepared mouthwashes
d.	Docosanol (Abreva) therapy
e.	Milk of Magnesia mouth rinses

 

 

ANS:  A, E

The pain with mucositis can be extremely severe. Viscous lidocaine 2% anesthetizes the entire mouth and throat. Used before meals, it facilitates patient eating. Care must be taken that the patient does not burn himself or herself because sensation is diminished. Milk of Magnesia can also be used as a mouth rinse to coat the mucous membranes. Acetylcysteine does not treat mucositis. Commercial mouthwashes contain alcohol, which is detrimental to the healing of mucositis. Docosanol is used to treat topical herpes infections, not mucositis.

 

DIF:    Cognitive Level: Application           REF:   Page 487        OBJ:   1 | 2 | 3

TOP:   Nursing Process Step: Implementation

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Inflammation; Pain; Patient Education

 

5. In addition to discomfort, which are adverse effects of xerostomia? (Select all that apply.)

a.	Reduced taste and appetite
b.	Excessive salivation
c.	Difficulty chewing and swallowing food
d.	Increase in dental caries
e.	Difficulty with speech
f.	Improved taste and enjoyment of food

 

 

ANS:  A, C, D, E

Xerostomia increases tooth decay and causes loss of taste, difficulty in chewing and swallowing food, and difficulty talking. Xerostomia does not cause excessive salivation or food to taste better.

 

DIF:    Cognitive Level: Comprehension     REF:   Page 486        OBJ:   1

TOP:   Nursing Process Step: Assessment

MSC:  NCLEX Client Needs Category: Physiological Integrity

NOT:  CONCEPT(S): Clinical Judgment; Nutrition; Safety; Communication