Chapter 29 Pharmacology For Nurses A Pathophysiologic Approach 5th Edition

Chapter 29 Pharmacology For Nurses A Pathophysiologic Approach 5th Edition

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

Question 1

Type: MCSA

The young patient has a history of multiple allergies, and the physician prescribed epinephrine (EpiPen) for prevention of anaphylactic shock. The patient’s mother says to the nurse, “I thought shock was about heart failure.” What is the best response by the nurse?

1. “There are many kinds of shock: heart failure, nervous system damage, loss of blood, and respiratory failure.”
2. “Allergic response is the most fatal type of shock; other types involve loss of blood, heart failure, and liver failure.”
3. “There are many kinds of shock that also include infection, nervous system damage, and loss of blood.”
4. “Heart failure is the most serious kind of shock; others include infection, kidney failure, and loss of blood.”

Correct Answer: 3

Rationale 1: Respiratory failure is not a type of shock.

Rationale 2: Liver failure is not a type of shock.

Rationale 3: Obvious bleeding suggests hypovolemic shock, trauma to the brain or spinal cord suggests neurogenic shock, inadequate cardiac output would suggest cardiogenic shock, a recent infection may indicate septic shock, and a history of allergies with a sudden onset of symptoms may suggest anaphylactic shock.

Rationale 4: Kidney failure is not a type of shock.

Global Rationale: Obvious bleeding suggests hypovolemic shock, trauma to the brain or spinal cord suggests neurogenic shock, inadequate cardiac output would suggest cardiogenic shock, a recent infection may indicate septic shock, and a history of allergies with a sudden onset of symptoms may suggest anaphylactic shock. Kidney failure is not a type of shock. Respiratory failure is not a type of shock. Liver failure is not a type of shock.

 

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: 29-1 Compare and contrast the different types of shock.

MNL Learning Outcome:

Page Number: 431

 

Question 2

Type: MCSA

The patient comes to the emergency department after suffering a bilateral traumatic amputation of his lower extremities. The physician orders normal serum albumin (Albuminar). The patient goes into shock. What will the best nursing assessment of this patient reveal?

1. B/P: 140/90 mmHg, P: 46, weak and irregular, R: 24, and shallow.
2. B/P: 50/0 mmHg, P: 126, weak and thready, R: 14, and shallow.
3. B/P: 80/20 mmHg, P: 122, weak and thready, R: 28, and shallow.
4. B/P: 130/88 mmHg, P: 90, bounding, R: 32, and shallow.

Correct Answer: 3

Rationale 1: A patient in shock will have a low blood pressure; the heart rate will be rapid, not slowed.

Rationale 2: A patient in shock will have rapid respirations; a respiratory rate of 14 is considered normal.

Rationale 3: The central problem with hypovolemic shock is the inability of the cardiovascular system to send sufficient blood to the vital organs, with the heart and brain being affected early in the progression of the disease. Assessing the patient’s cardiovascular status will result in a blood pressure that is low; a heart rate that may be rapid with a weak, thready pulse; and breathing that is rapid and shallow.

Rationale 4: A patient in shock will have a low blood pressure and a rapid, weak, not bounding, pulse.

Global Rationale: The central problem with hypovolemic shock is the inability of the cardiovascular system to send sufficient blood to the vital organs, with the heart and brain being affected early in the progression of the disease. Assessing the patient’s cardiovascular status will result in a blood pressure that is low; a heart rate that may be rapid with a weak, thready pulse; and breathing that is rapid and shallow. A patient in shock will have a low blood pressure and a rapid, weak, not bounding, pulse. A patient in shock will have rapid respirations; a respiratory rate of 14 is considered normal. A patient in shock will have a low blood pressure; the heart rate will be rapid, not slowed.

 

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: 29-2 Relate the general symptoms of shock to their physiological causes.

MNL Learning Outcome:

Page Number: 431

 

Question 3

Type: MCSA

The patient is recovering from hypovolemic shock. The nurse hangs a bag of normal human serum albumin (Albutein) and educates the patient about this fluid. The nurse evaluates that learning has occurred when the patient makes which statement?

1. “It is a protein that pulls water into my blood vessels.”
2. “It is a protein that causes my kidneys to conserve fluid.”
3. “It is a super-concentrated salt solution that helps me conserve body fluid.”
4. “It is a liquid that has electrolytes in it to pull water into my blood vessels.”

Correct Answer: 1

Rationale 1: Colloids are proteins or other large molecules that stay suspended in the blood for long periods because they are too large to easily cross membranes. They draw water molecules from the cells and tissues into the blood vessels through their ability to increase plasma oncotic pressure.

Rationale 2: Normal human serum albumin (Albutein) does not act on the kidneys.

Rationale 3: Normal human serum albumin is not a concentrated saline solution.

Rationale 4: Crystalloids are intravenous (IV) solutions that contain electrolytes, not proteins, in concentrations resembling those of plasma.

Global Rationale: Colloids are proteins or other large molecules that stay suspended in the blood for long periods because they are too large to easily cross membranes. They draw water molecules from the cells and tissues into the blood vessels through their ability to increase plasma oncotic pressure. Crystalloids are intravenous (IV) solutions that contain electrolytes, not proteins, in concentrations resembling those of plasma. They are used to replace lost fluids and promote urine output. Normal human serum albumin (Albutein) does not act on the kidneys. Normal human serum albumin is not a concentrated saline solution.

 

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

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: 29-4 Compare and contrast the use of blood products, colloids, and crystalloids in fluid replacement therapy.

MNL Learning Outcome:

Page Number: 433

 

Question 4

Type: MCSA

The patient is in shock with a blood pressure of 60/20 mmHg. The physician orders dobutamine intravenously (IV). The family is quite anxious and asks what “that liquid” is for. What is the best response of the nurse?

1. “This drug is a vasopressor and helps the heart beat more effectively, which will increase blood pressure.”
2. “Vasopressor drugs act on the renin-angiotension system and thus increase blood pressure.”
3. “This drug is a vasopressor and will help stabilize blood pressure by making the blood vessels smaller.”
4. “It is called a vasopressor and will help increase blood flow to peripheral muscles.”

Correct Answer: 3

Rationale 1: Vasopressors do not increase cardiac contractility.

Rationale 2: Vasopressors do not affect the renin-angiotension system.

Rationale 3: In early shock, the body compensates for the fall in blood pressure by activating the sympathetic nervous system. The body’s ability is limited, so sympathomimetic vasoconstrictors, known as vasopressors, have been used to stabilize blood pressure in shock patients.

Rationale 4: Vasopressors do not increase blood flow to peripheral muscles.

Global Rationale: In early shock, the body compensates for the fall in blood pressure by activating the sympathetic nervous system. The body’s ability is limited, so sympathomimetic vasoconstrictors, known as vasopressors, have been used to stabilize blood pressure in shock patients. Vasopressors do not increase blood flow to peripheral muscles. Vasopressors do not increase cardiac contractility. Vasopressors do not affect the renin-angiotension system.

 

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: 29-5 Explain the rationale for using vasoconstrictors and inotropic drugs to treat shock.

MNL Learning Outcome:

Page Number: 434