Chapter 01: Pharmacology and the Nursing Process in LPN Practice Visovsky:Introduction to Clinical Pharmacology, 10th Edition

1. The LPN is collecting data for the initial assessment of a patient upon admission to a

Long-term care facility before giving the patient's prescribed drugs. Which action should the LPNconsider to

be the highest priority

Collect data about the patient and the patient's health condition

The LPN is working with a patient in the planning stage of the nursing process related tothe

patient's prescribed drugs. Which action should the LPN take during this stage?

Determine how much the patient understands about his drug.

You are teaching a patient with depression about the potential adverse effects of a

prescribed drug. What part of the nursing process related to drug therapy are you engaging in at

this point of the teaching plan?

evaluation

Which statement provides an example of objective data?

Grimacing with movement is present during the examination.

The LPN/VN is assessing a patient before giving a drug for blood pressure management.

The nurse notes the blood pressure to be 90/50 mm Hg. What is the nurse's best action?

Hold the drug and report the blood pressure to the RN.

The LPN is collecting objective data for inclusion in the nursing assessment. Which piece

of information indicates that the LPN has a clear understanding of objective assessment data?

Compilation of past laboratory results and x-ray reports.

A patient recently began a taking blood pressure drug and presents for a follow-up

appointment. The office nurse reviews the patient's daily blood pressure recordings. Which stage

of the nursing process corresponds to this review?

Evaluation

After receiving report, the LPN gives drugs to her assigned patients on the evening shift.

With which stage of the nursing process does this activity correspond?

implementation

You are reviewing a patient's new antihypertensive drug order. The order as written is

unclear as to the number of times per day the drug is to be given. What is your best action?

Call the healthcare provider to clarify the order

A patient is receiving an antibiotic for pneumonia. On the third day of the treatment

regimen, a rash appears on her chest, and she reports itching and shortness of breath. Which term

describes the effect that has occurred?

Adverse effect

An itchy rash with shortness of breath that develops in response to drug is an example of an allergic reaction or adverse effect to

the antibiotic. Therapeutic effects occur when an antibiotic fights infection without causing any adverse effects. Side effects of

drugs are known potential effects of the antibiotic that range from mild to moderate. An overdose occurs if a patient receives too

much of a drug.

An LPN enters a patient's room to give a scheduled drug. Before administration, the

patient states, "I can't take that drug; I'm allergic to it." What should the nurse do first?

Assess the patient's allergic history and notify the healthcare provider to determine a

course of action.

The LPN is preparing to give the initial dose of an antibiotic to a patient diagnosed with

an infection. The patient says, "I broke out in a rash the last time I took that pill." What action

should the LPN take next?

Notify the registered nurse or healthcare provider.

Which priority assessment must you make before giving any patient a drug by mouth?

Make sure the patient can swallow

You are preparing to give the morning drugs to your assigned patients. Before giving

each drug, which steps are considered to be "rights" of giving a drug? (Select all that apply.)

The right time

The right dose

The right patient

The right patient

A licensed practical/vocational nurse has a specific set of roles and responsibilities.

Which responsibilities are within the scope of an LPN/LVN? (Select all that apply.)

- Assessment of admission vitals to report to the admitting RN

- Management of patient care under RN supervision

Assisting the RN in gathering specific data such as vital signs is within the scope of LPN/LVN practice. The LPN/LVN works

directly with the patient and manages care and assists the RN in data collection and care plan development. The LPN/LVN does not

have the legal authority to write medical orders or carry out the admission assessment. LPNs/LVNs are more dependent in the

planning and evaluation phase of the nursing process. An LPN/LVN can collect data to assist the RN with care plan development

but is unable to initiate a comprehensive plan of care independently.

The LPN is collecting subjective data for inclusion in the nursing assessment. What

information indicates that the LPN has a clear understanding of the nature of subjective

assessment data? (Select all that apply .)

- Chief complaint of chest pain in the patient's own words

- The patient's statement of current over the counter and prescription drugs

Subjective data include information given by the patient or family, like concerns or symptoms felt by the patient, and their

statement of mediations. The pulse rate, recent ECG, laboratory test results, and lung auscultation obtained through physical

examination are examples of objective data.

A 72 year-old female patient has just been admitted to a rehabilitation center for extended

physical therapy following a stroke. You are obtaining the patient's drug history. Which

information should you collect? (Select all that apply.)

Drugs currently being taken

Over-the-counter drugs being taken

Diseases or conditions requiring drugs

Use of herbal supplements

Past medical history

Alcohol use

Drug allergies

Chapter 02: Legal, Regulatory, and Ethical Aspects of Drug Administration

Visovsky: Introduction to Clinical Pharmacology, 10th Edition

MULTIPLE CHOICE

You have obtained a liquid narcotic for a patient in pain from the unit's locked cabinet.

However, the dose was accidentally spilled before giving it to the patient. What is the best action to

take at this point?

Ask another nurse to cosign the inventory record describing the situation

As you arrive to work, a nurse from the previous shift tells you that she has completed the

narcotic count for your shift. What action should be taken?

Recount the narcotics again with a nurse from the previous shift.

A one-time order for a controlled substance drug has been written for a patient you are caring

for. However, the drug ordered is available only in a larger dose than is needed. What should you

do with the remaining drug

Have another nurse witness the wasting of the leftover drug, and document according to policy.

An elderly patient in an assisted living home requests an over-the-counter cough preparation for

a mild cough she is experiencing.

What is your best response?

"I will need to contact your healthcare provider for an order before I can give this drug to you."

Which of the following orders is an example of a single drug order

Cefazolin 1 g IV 8 a.m. before surgery

Diphenhydramine 50 mg IV push is ordered by the healthcare provider to be given "stat." When

should this drug be given?

Immediately

You are giving drugs to the patients assigned to you when you realize that you gave a drug to the

wrong patient. What action should you take?

Evaluate the patient's condition and notify the healthcare provider.

Which of the following drugs is considered a high alert drug? (Select all that apply.)

Insulin

Heparin

Potassium

Which of the following scenarios may be a sign of possible drug diversion on a unit? (Select all

that apply.)

A patient receiving opioids reports increased pain

A nurse reports the narcotic count is inaccurate

A 90-year-old woman with dementia is refusing to take her prescribed morning drugs. Another

nurse urges you to mix her drugs into some applesauce and feed it to her as a way to give her drug.

Which of the following actions should you take before you give a drug mixed into food or drink?

List the appropriate actions. (Select all that apply.)

Inform the patient or family

Document the mixing of drugs in food or drink in the chart.

Inform the healthcare provider.

You have just completed giving the patient drugs for your shift when you discover that you

made a drug administration error. What steps should you take? (Select all that apply.)

Fill out an incident report as soon as possible

Call the healthcare provider immediately.

Check your patient and assess vital signs.

You are caring for an elderly patient who was just admitted the rehabilitation unit following a

hospitalization for a fractured hip.

You suspect that in the transfer from the hospital to the rehabilitation unit an error in the patient's?

Call the pharmacy.

Clarify anything that is unreadable

Clarify vague orders with the healthcare provider.

Check the original written order with the healthcare provider.

Which levels of regulation must you adhere to when giving drugs to a patient? (Select all that

apply.)

- State Regulations

- Federal Regulations

- Institutional Regulations

A narcotic control system is used in any hospital or agency. Which of the following are special

regulations applied for control of narcotics that you must follow? List the special regulations

applied for the control of narcotics that the nurse must follow. (Select all that apply.)

Narcotics are stored in a special locked cabinet

An inventory of the narcotics on a unit must be kept and verified by two nurses.

You are responsible for signing out every narcotic drug used for a patien

A discrepancy in the narcotics inventory for morphine 5 mg/mL vials is discovered when the

narcotics count is performed. The count is short by one vial. Which of the following steps should

you take to reconcile the count? (Select all that apply.)

Notify the nursing supervisor and the pharmacy of the discrepancy.

Identify if any nurse forgot to record any of the narcotics removed.

Check drug records to reconcile if narcotics given and not signed for.

Notify the security department of the institution if drug diversion is suspected.

Chapter 03: Principles of Pharmacology Visovsky: Introduction to Clinical

Pharmacology, 10th Edition

MULTIPLE CHOICE

Which is always true regarding the generic name for a drug?

The generic name is the same in any country.

What is the difference between the generic and the trade names of drugs?

The trade name is one that is registered to a specific drug manufacturer.

You are giving the drug antagonist naloxone (Narcan) to a patient who has experienced an

opioid overdose. What response would you expect in this patient from a drug antagonist?

An opioid antagonist would result in no activation of cell receptors.

You have just given a patient a drug that is a known agonist. The patient asks how this drug is

expected to work. What is your best response?

This drug works by attaching to the receptor site to activate it.

You are giving an oral drug to a patient who asks you to explain the reason for taking water

with an oral tablet. What is your best response?

"Water helps to dissolve the drug."

You are about to give an IV antibiotic to a patient hospitalized with severe cellulitis of the right

leg. The patient asks why the drug is being given by the intravenous route instead of by mouth.

What is your best response?

"This antibiotic can act faster if given by IV than if given by mouth."

What is the process by which drug molecules move from a region of higher concentration to

one of lower concentration?

Diffusion

In diffusion, molecules move from a region of higher concentration to one of lower concentration.

A 62-year-old male patient with liver disease asks you why he is receiving a drug intravenously

rather than by mouth. What is your best response?

"Your liver disease impairs the transformation of a drug into its active form."

A patient who is beginning a new cholesterol-lowering drug tells you he plans to take this drug in the evening with his usual glass of grapefruit juice. What is your best response?

"Taking grapefruit juice can reduce the effectiveness of the drug."

You give a patient 400 mg of an oral drug at noon. This drug has a half-life of 2 hours. At

what time will 100 mg remain?

4:00 p.m.

With a half-life of 2 hours, the amount of drug remaining in the blood decreases by 50% every 2 hours. So, when 400 mg are given

at noon, by 2:00 p.m., 200 mg remain; by 4:00 p.m., 100 mg remain.

When teaching a patient about a new drug that has been prescribed, the patient asks you to

explain the difference between a side effect and an adverse reaction. What is your best response?

Side effects are mild, and adverse effects are severe.

A 42-year-old female patient recovering from a recent fall tells you that she is experiencing

sleepiness after taking a drug prescribed for back pain. What is your best response?

"You are having an expected drug side effect."

A 27-year-old male patient with a sexually transmitted infection who was given intramuscular

penicillin develops hives, itching, and facial swelling after the injection. What type of drug

reaction is this patient experiencing?

hypersensitivity reaction

A 21-year-old woman has been prescribed a 10-day course of an oral antibiotic for a sinus

infection. What information should be included in the teaching plan for this patient?

Antibiotics interact with birth control pills making them less effective.

Probenecid is sometimes given to patients taking penicillin to increase the amount of

penicillin absorbed. Which effect is this an example of?

additive effect

A patient who has been prescribed an antianxiety drug to be taken in the evening tells you he

has 2 to 3 beers with dinner each night. What is your best response?

"Drinking any alcohol with this drug can have a harmful additive effect."

You are caring for a patient with liver failure who will be starting on an oral anticoagulant for

the treatment of a deep vein thrombosis. What effect of this drug should you expect?

The effect of the anticoagulant will be prolonged and pose a risk for bleeding.

Which statement concerning absorption of oral drugs is true for neonates?

Oral drugs are poorly absorbed for the gastrointestinal tract of the neonate.

The nurse receives an order to give methylprednisolone 125 mg/1 mL IM. The nurse knows that she should inject this drug into the -----------to assure the drug is absorbed most rapidly?

Deltoid Muscle

You are preparing to give an oral drug to a patient. You are aware that in order for the drug to

be used by the body, the drug needs--------------- to be absorbed through the processes of --------, -

------------and to move drug molecules.Using into the circulation?

diffusion; filtration; osmosis; passive transport

MULTIPLE RESPONSE

1. Which of the following factors are known to influence drug distribution? (Select all that apply.)

Drug binding

Tissue type

Cell membrane penetration

Tissue perfusion

Which of the following routes are sites of excretion of drug metabolites from the body? (Select

all that apply.)

Feces, urine, and breast milk

What are the possible responses a patient can have to a drug's actions? (Select all that apply.)

Desired action

Adverse effects

Side effects

A nurse working at an assisted living facility knows that there are certain pharmacologic

challenges in older adults. Which of the following issues related to drug therapy in older patients

are true? (Select all that apply.)

Drugs are secreted more slowly in older patients,

Adverse drug reactions are more common in older patients, Dehydration can cause the blood level of drug to increase in older patients,

Loss of electrolytes due to diuretics can result in loss of electrolytes in older

patients.