Chapter 31 Pharmacology For Nurses A Pathophysiologic Approach 5th Edition

Chapter 31 Pharmacology For Nurses A Pathophysiologic Approach 5th Edition

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

Question 1

Type: MCSA

The nurse is managing care for a patient with cirrhosis of the liver. The nurse teaches the patient about how to avoid injury that may result in bleeding. The patient asks the nurse why he is at risk to start bleeding. What is the best response by the nurse?

1. “Because your liver is injured and unable to manufacture platelets.”
2. “Because your liver thickens your blood so it is less likely to clot.”
3. “Because your liver is injured and cannot make clotting factors.”
4. “Because your liver is breaking down your clotting factors too quickly.”

Correct Answer: 3

Rationale 1: The liver is not responsible for manufacturing platelets.

Rationale 2: The liver is not responsible for making the blood thick.

Rationale 3: The liver is responsible for the production of essential clotting factors necessary to prevent bleeding.

Rationale 4: The liver is not responsible for breaking down clotting factors.

Global Rationale: The liver is responsible for the production of essential clotting factors necessary to prevent bleeding. The liver is not responsible for breaking down clotting factors. The liver is not responsible for making the blood thick. The liver is not responsible for manufacturing platelets.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Physiological Adaptation

QSEN Competencies: III.A.1 Demonstrate knowledge of basic scientific methods and processes.

AACN Essentials Competencies: III.1 Explain the interrelationships among theory, practice, and research.

NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines.

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 31-1 Illustrate the major steps of hemostasis and fibrinolysis.

MNL Learning Outcome: 4.5.1 Examine etiology, pathophysiology, and clinical manifestations.

Page Number: 462

 

Question 2

Type: MCSA

The nurse is managing care for a patient with a DVT (deep vein thrombosis) of the right calf. The patient receives heparin intravenously (IV). What is the priority outcome for this patient?

1. The patient will comply with dietary restrictions.
2. The patient will keep the right leg elevated on two pillows.
3. The patient will not disturb the intravenous infusion.
4. The patient will not experience bleeding.

Correct Answer: 4

Rationale 1: Dietary restrictions are important but not the highest priority.

Rationale 2: Elevation of the affected extremity is important but not the highest priority.

Rationale 3: Disturbing the intravenous (IV) could relate to bleeding, but this does not directly correlate with heparin.

Rationale 4: An absence of bleeding is a priority outcome for any patient receiving anticoagulant therapy.

Global Rationale: An absence of bleeding is a priority outcome for any patient receiving anticoagulant therapy. Disturbing the intravenous (IV) could relate to bleeding, but this does not directly correlate with heparin. Dietary restrictions are important but not as high of a priority as an absence of bleeding. Elevation of the affected extremity is important but not as high of a priority as an absence of bleeding.

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: I.B.15 Communicate care provided and needed at each transition in care.

AACN Essentials Competencies: IX.8 Implement evidence-based nursing interventions as appropriate for managing the acute and chronic care of patients and promoting health across the lifespan.

NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care.

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 31-5 Describe the nurse’s role in the pharmacologic management of coagulation disorders.

MNL Learning Outcome: 4.5.4 Apply the nursing process to pharmacotherapy, safe drug administration, and client education.

Page Number: 467

 

Question 3

Type: MCSA

The patient receives warfarin (Coumadin). The nurse notes that the patient’s morning international normalized ratio (INR) is 7–. What are the priority nursing interventions at this time?

1. Hold the next dose of warfarin (Coumadin) and repeat the international normalized ratio (INR).
2. Administer protamine sulfate and hold the next dose of warfarin (Coumadin).
3. Hold the next dose of warfarin (Coumadin) and contact the physician.
4. Administer vitamin K and hold the next dose of warfarin (Coumadin).

Correct Answer: 4

Rationale 1: Repeating the international normalized ratio (INR) is appropriate but not the highest priority.

Rationale 2: Protamine sulfate is the antidote for heparin, not warfarin.

Rationale 3: Consulting the physician is appropriate but not the highest priority.

Rationale 4: Vitamin K is the antidote for warfarin (Coumadin) overdose, and its administration is warranted with an international normalized ratio (INR) of 7–.

Global Rationale: Vitamin K is the antidote for warfarin (Coumadin) overdose, and its administration is warranted with an international normalized ratio (INR) of 7–. Repeating the international normalized ratio (INR) is appropriate, but the patient must receive vitamin K immediately. Protamine sulfate is the antidote for heparin, not warfarin. Consulting the physician is appropriate, but the patient must receive vitamin K immediately.

 

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: V.B.1 Demonstrate effective use of technology and standardized practices that support safety and quality.

AACN Essentials Competencies: IV.6 Evaluate data from all relevant sources, including technology, to inform the delivery of care.

NLN Competencies: Knowledge and Science: Integration of knowledge from nursing and other disciplines.

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 31-4 Explain how laboratory testing of coagulation parameters is used to monitor anticoagulant pharmacotherapy.

MNL Learning Outcome: 4.5.1 Examine etiology, pathophysiology, and clinical manifestations.

Page Number: 469

 

Question 4

Type: MCMA

The physician orders pentoxifylline (Trental) for the patient with peripheral vascular disease. The nurse has completed medication education and determines that learning has occurred when the patient makes which statement(s)?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. “It makes my red blood cells (RBCs) squishy so they can go into the little blood vessels.”
2. “It decreases my platelets so my blood is less likely to clot.”
3. “It decreases the “stickiness” of my blood.”
4. “It changes how my liver makes clotting factors.”
5. “It destroys clotting factors.”

Correct Answer: 1,2,3

Rationale 1: Pentoxifylline (Trental) acts on red blood cells (RBCs) to reduce their viscosity and increase their flexibility to allow them to enter partially occluded vessels.

Rationale 2: Pentoxifylline (Trental) also has antiplatelet action.

Rationale 3: Pentoxifylline (Trental) decreases the viscosity or “stickiness” of blood.

Rationale 4: Pentoxifylline (Trental) does not interfere with the manufacture of clotting factors in the liver.

Rationale 5: Pentoxifylline (Trental) does not destroy clotting factors.

Global Rationale: Pentoxifylline (Trental) acts on red blood cells (RBCs) to reduce their viscosity and increase their flexibility to allow them to enter partially occluded vessels. Pentoxifylline (Trental) also has antiplatelet action. Pentoxifylline (Trental) decreases the viscosity or “stickiness” of blood. Pentoxifylline (Trental) does not destroy clotting factors. Pentoxifylline (Trental) does not interfere with the manufacture of clotting factors in the liver.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

QSEN Competencies: I.B.3 Provide patient-centered care with sensitivity and respect for the diversity of human experience.

AACN Essentials Competencies: IX.3 Implement holistic, patient-centered care that reflects an understanding of human growth and development, pathophysiology, pharmacology, medical management and nursing management across the health-illness continuum, across lifespan, and in all healthcare settings.

NLN Competencies: Knowledge and Science: Relationships between knowledge/science and quality and safe nursing care.

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 31-7 Use the nursing process to care for patients receiving pharmacotherapy for coagulation disorders.

MNL Learning Outcome: 5.4.4 Apply the nursing process to pharmacotherapy, safe drug administration, and client education.

Page Number: 468