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Chapter 5: Lifespan and Cultural Modifications
Edmunds: Introduction to Clinical Pharmacology, 8th Edition
MULTIPLE CHOICE
1.A mother asks why her 6-year-old requires a daily dose of digoxin that is twice that of an adult. The nurse explains that the larger dose is necessary because of which characteristics of children?
| a. | Greater resistance to medications |
| b. | Variations in development of drug receptors |
| c. | A slower metabolic rate than adults |
| d. | More total body water, which dilutes the drug |
ANS: B
Infants and children require a total daily digoxin dose that is approximately twice that of an adult on a basis of the ratio of weight to dose. This increased requirement for digoxin is thought to be the result of a greater binding strength of the child’s developing myocardial digoxin receptors.
DIF: Cognitive Level: Apply REF: p. 48 OBJ: 1
TOP:ExcretionKEY:Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity
2.Which statement made by an older adult patient would require further teaching by the nurse?
| a. | “Nonprescription drugs will not interfere with my prescribed medications.” |
| b. | “I can get non-childproof lids for my pills from the pharmacist.” |
| c. | “Alcohol can affect drug action.” |
| d. | “I will report any signs of drug toxicity to my doctor.” |
ANS: A
You must be sure that older adult patients are taught how to take their prescription medications and about the danger of taking nonprescription drugs at the same time. Elderly patients often have age-related decline in renal and hepatic function, which can affect how their bodies handle many over-the-counter (OTC) drugs and prescription drugs. They may also have some loss in “hepatic reserve,” thereby placing them at increased risk of adverse effects when drugs are added to their existing treatment plan. The risk of adverse drug interactions is also increased if the elderly patients’ physicians don’t know all the drugs they are taking.
DIF: Cognitive Level: Apply REF: p. 51 OBJ: 1
TOP: Patient Teaching KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
3.An older adult woman comes into the clinic complaining of “feeling bad” since yesterday. She tells the nurse her husband gave her his medication for a headache. Which represents the best response to this information?
| a. | “The cost of medication is high, so sharing is okay, since he has no problems.” |
| b. | “You both have the same health problems, so sharing is all right.” |
| c. | “Monitoring the drug effect is easier, since he also takes the medication.” |
| d. | “When you take his medication, it makes evaluating the effects of your medication harder.” |
ANS: D
Many older patients also diagnose each other’s health problems and share medications, which may make it very difficult for you to evaluate the effects of prescribed medications in a particular patient. Include the dangers of this in patient teaching.
DIF: Cognitive Level: Apply REF: p. 51 OBJ: 1
TOP: Patient Teaching Considerations KEY: Nursing Process Step: Assessment
MSC:NCLEX: Physiological Integrity: Reduction of Risk Potential
4.A pregnant patient asks the nurse what “teratogenic effect” of medications means. Which is the nurse’s best response?
| a. | The ability to cause damage to the pregnant woman |
| b. | A type of anaphylactic reaction in the pregnant woman |
| c. | The ability to cause damage to the fetus |
| d. | A term for stating the therapeutic effect of the medication for the fetus |
ANS: C
All mothers want to have healthy babies, so it is important for pregnant women to avoid as many drugs as possible, especially those drugs with teratogenic potential (those likely to cause malformations or damage in the embryo or fetus).
DIF: Cognitive Level: Remember REF: p. 52 OBJ: 1
TOP:Pregnant and Breastfeeding Women
KEY:Nursing Process Step: Assessment
MSC:NCLEX: Physiological Integrity: Reduction of Risk Potential
5.A young woman comes into the clinic for follow-up care after a sexually transmitted infection. Which statement made by this patient alerts the nurse that further explanation is needed about her use of oral contraceptive pills (OCPs)?
| a. | “The OCPs will stop infections.” |
| b. | “The OCPs will not cause infection.” |
| c. | “I will continue the OCPs if I get an infection.” |
| d. | “I need to use a backup means of contraception while taking an antibiotic.” |
ANS: A
Oral contraceptive pills do not reduce a patient’s risk of getting a sexually transmitted disease.
DIF: Cognitive Level: Apply REF: p. 52 OBJ: 3
TOP: Women’s Health Issues KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity
6.Which action by a breastfeeding mother who takes medication would decrease the amount of the drug the baby receives in breast milk?
| a. | Always using sustained-release medications |
| b. | Taking medication just before breastfeeding |
| c. | Taking medication in the morning |
| d. | Expressing and discarding milk when feedings are skipped |
ANS: D
If a feeding is skipped, the mother needs to express and discard her breast milk, because drug levels may build up in the milk.
DIF: Cognitive Level: Analyze REF: p. 53 OBJ: 1
TOP: Breastfeeding Women KEY: Nursing Process Step: N/A
MSC:NCLEX: Physiological Integrity: Reduction of Risk Potential
7.Hormone replacement therapy for menopausal women helps reduce the incidence of which condition?
| a. | Varicose veins |
| b. | Osteoporosis |
| c. | Hypertension |
| d. | Depression |
ANS: B
Hormone replacement therapy for menopause has been used to reduce calcium loss from bones, which leads to osteoporosis.
DIF: Cognitive Level: Remember REF: p. 52 OBJ: 3
TOP: Women’s Health Issues KEY: Nursing Process Step: N/A
MSC: NCLEX: Health Promotion and Maintenance
8.A Hispanic patient in the hospital has been told that medication is recommended for his condition. He tells the nurse that he would like to consult the curandera before making a decision. What should the nurse do first?
| a. | Talk with the patient about his cultural beliefs related to health. |
| b. | Inform the physician of the patient’s request. |
| c. | Restrict contact between the patient and the curandera. |
| d. | Talk with the family about the request. |
ANS: A
The LPN/LVN should attempt to accept and work with the cultural practices of patients as much as possible and not force patients to accept care that conflicts with their values.
DIF: Cognitive Level: Apply REF: p. 56 OBJ: 2
TOP: Cultural Influences KEY: Nursing Process Step: Implementation
MSC: NCLEX: Psychosocial Integrity
9.Which individual would be at the highest risk for drug noncompliance?
| a. | A 2-year-old in a day care center |
| b. | A 10-year-old receiving antibiotics for an ear infection |
| c. | A 65-year-old on a fixed income taking multiple medications |
| d. | A 95-year-old in a long-term care facility taking multiple medications |
ANS: C
The patient’s age, sex, race, education, occupation, income, and marital status usually provide clues about whether the patient will follow medication instructions or not.
DIF: Cognitive Level: Analyze REF: p. 59 OBJ: 3
TOP: Noncompliance KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity
10.Which nursing intervention would be most helpful in improving a patient’s ability to follow the drug treatment plan?
| a. | Obtaining a unit-dose dispensing system for home use |
| b. | Providing instruction three times before discharge |
| c. | Discussing the medications with a family member |
| d. | Establishing a good nurse-patient relationship |
ANS: D
Factors that have been identified as helpful in having a good relationship with the patient include being friendly with a positive, confident approach.
DIF: Cognitive Level: Analyze REF: pp. 58-59 OBJ: 3
TOP: Noncompliance KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
11.A mother comes to the clinic with her 7-year-old son who has had a cold for 2 days. She has been giving the child an over-the-counter preparation for his cough. The mother tells the nurse the child has been very hyperactive since his illness. What would the nurse assessing this patient tell the mother?
| a. | “Keep him busy. He will soon get tired and fall asleep.” |
| b. | “All children act this way when they are ill and want attention.” |
| c. | “Over-the-counter medication may cause reactions in children.” |
| d. | “Over-the-counter medication is not strong enough to cause a reaction.” |
ANS: C
Over-the-counter preparations, particularly various cough syrups, may provoke adverse reactions in pediatric patients. Many over-the-counter cold meds now carry warnings against giving them to children.
DIF: Cognitive Level: Apply REF: p. 49 OBJ: 1
TOP: Adverse Reactions KEY: Nursing Process Step: Assessment
MSC:NCLEX: Physiological Integrity: Reduction of Risk Potential
12.The nurse is counseling a young woman who is planning her pregnancy. She asks if there is anything she might do to help prevent birth defects in her unborn child. Which would be an appropriate response to the patient?
| a. | “There is no way you can prevent a natural condition.” |
| b. | “Birth defects only happen occasionally to some people.” |
| c. | “Eating a diet rich in iron may prevent or stop birth defects.” |
| d. | “Taking multivitamins with folic acid will help prevent birth defects.” |
ANS: D
There is now a great deal of scientific data that support eating foods high in folic acid or taking a multivitamin with folic acid to protect against certain birth defects.
DIF: Cognitive Level: Apply REF: pp. 51-52 OBJ: 1
TOP: Women’s Health Issues KEY: Nursing Process Step: Planning
MSC:NCLEX: Physiological Integrity: Reduction of Risk Potential
13.The nurse instructs a woman on hormone replacement therapy (HRT) and informs her of the risk for which conditions?
| a. | Hot flashes |
| b. | Increased calcium deposits |
| c. | Heart attack |
| d. | Weight loss |
ANS: C
Research has shown that HRT may lead to an increased risk for heart attack.
DIF: Cognitive Level: Apply REF: p. 52 OBJ: 1
TOP: Women’s Health Issues KEY: Nursing Process Step: Implementation
MSC:NCLEX: Physiological Integrity: Reduction of Risk Potential
14.The nurse is administering naproxen to a 70-year-old patient with poor nutritional intake. What should the nurse assess prior to administering the medication?
| a. | Blood pressure |
| b. | Heart rate |
| c. | Oxygen saturation level |
| d. | Albumin level |
ANS: D
The nurse should assess the patient’s albumin level prior to administering naproxen. Older adults may have decreased serum albumin levels due to the aging process. Naproxen is a high-protein binding drug. Decreased levels of albumin places the patient potentially at risk for high serum levels of naproxen. This may lead to increased effects of the drug or drug toxicity.
DIF: Cognitive Level: Apply REF: p. 50 OBJ: 1
TOP: Geriatric Special Considerations KEY: Nursing Process Step: Assessment
MSC:NCLEX: Physiological Integrity: Reduction of Risk Potential
15.A patient with HIV has been diagnosed with Candida albicans. The nurses can anticipate the physician will order medication to be taken over how many days?
| a. | 10 days |
| b. | 7 days |
| c. | 14 days |
| d. | 2 days |
ANS: D
Candida infection is being treated by newer antifungal medications that have cut the treatment time from 7 to 2 days. These products are commonly prescribed for women with vaginal infections and AIDS patients with reduced immunity.
DIF: Cognitive Level: Understand REF: p. 51 OBJ: 2
TOP: Health Issues KEY: Nursing Process Step: N/A
MSC:NCLEX: Physiological Integrity: Reduction of Risk Potential
MULTIPLE RESPONSE
16.Which people, as a condition of their work, are required to maintain current immunizations? (Select all that apply.)
| a. | People in the military |
| b. | Chefs |
| c. | Health care providers |
| d. | Cosmetologists |
| e. | Teachers |
ANS: A, B
People who travel outside the United States, are in the military, or work in handling food are required to have immunizations against many diseases. People at high risk, such as health care workers, older adults, and those who are immunocompromised, are encouraged to obtain yearly injections to help protect them against current strains of influenza.
DIF: Cognitive Level: Analyze REF: p. 55 OBJ: 2
TOP: Immunizations KEY: Nursing Process Step: N/A
MSC: NCLEX: Safe, Effective Care Environment: Safety and Infection Control
17.In aging patients, distribution of drugs may be lessened because of a decline in total body water and lean body mass, warranting the use of decreased dosing. Which drugs are distributed into body water or lean muscle mass and may lead to increased effects and possible toxicity for the aging patient? (Select all that apply.)
| a. | Digoxin (Lanoxin) |
| b. | Gentamicin (Garamycin) |
| c. | Meperidine (Demerol) |
| d. | Acetaminophen (Tylenol) |
| e. | Ibuprofen (Motrin) |
ANS: A, B, C
Drugs that are distributed into body water or lean body mass include digoxin, cimetidine, lithium, gentamicin, meperidine, phenytoin, and theophylline.
DIF: Cognitive Level: Apply REF: pp. 49-50 OBJ: 1
TOP: Distribution of Drugs KEY: Nursing Process Step: N/A
MSC:NCLEX: Safe, Effective Care Environment: Coordinated Care
18.What may the nurse question the patient about when performing a cultural assessment? (Select all that apply.)
| a. | Differences in values |
| b. | Religious practices |
| c. | Health practices |
| d. | Tolerance practices |
| e. | Political values and beliefs |
ANS: A, B, C
Cultural assessment involves talking with a patient about differences in values, religion, dietary practices, family lines of authority, family life patterns, and beliefs and practices related to health and illness.
DIF: Cognitive Level: Understand REF: p. 56 OBJ: 2
TOP: Cultural Inferences KEY: Nursing Process Step: Assessment
MSC:NCLEX: Safe, Effective Care Environment: Coordinated Care
19.Nurses working with older adult patients must remember which factors about their kidney function and administration of their medications? (Select all that apply.)
| a. | Older adult patients are all alike with regard to kidney function and medications. |
| b. | Drugs excreted by the kidney must be assessed individually in older adults. |
| c. | The nurse should remember factors about liver function only and not kidney function in older adults. |
| d. | Longer dosage intervals and lower doses are generally appropriate for older adults with kidney damage. |
| e. | With older adults, creatinine clearance values help measure kidney function. |
ANS: B, D, E
The important factors to remember when caring for older adult patients taking drugs that will be excreted from the kidney are to monitor these patients individually, follow creatinine clearance as prescribed by the health care provider, and expect that lower doses or longer intervals between doses may be ordered for patients with possible kidney damage.
DIF: Cognitive Level: Understand REF: p. 50 OBJ: 1
TOP:ExcretionKEY:Nursing Process Step: Planning
MSC: NCLEX: Physiological Integrity
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