ANSWER KEY Chapter 1 NCLEX-RN Review

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1 ANSWER KEY Chapter 1 NCLEX-RN Review 1. Drug indications tell what the health issues the drug can be used to treat. Rationale: Indications are the health issues for which a particular drug is approved. Options (a), (b), and (d) are incorrect. The chemical composition is found in the chemical name of the drug. The safe dosage is the amount of drug that can be given to a particular client. The adverse effects of the drug and found in literature about the drug but are not part of the drug indications. Client Need: Safe, Effective Care Environment 2. Trade. Rationale: Trade names or proprietary names are designed to help the client remember the name of the drug. Options (a), (b), and (d) are incorrect. The chemical name refers to the chemical substances that comprise the drug. A drug s generic name is assigned by the U.S. Adopted Name Council, and each drug has only one generic name. There is no category that is referred to as standard in the categories of drug names. 3. Pharmacotherapy is used to prevent and treat a wide variety of diseases. Rationale: Drugs are merely tools that are part of the overall therapeutic treatment plan. Other treatment options and the nurse-client relationship are also important to the care of the client as an individual. Options (a), (b) and (c) are incorrect. Pharmocotherapy involves the healthcare provider, nurse and other healthcare individuals in addition to the pharmacist. Pharmacotherapy includes herbal treatments when the treatment is considered to be a drug. It includes all drugs that are used in the treatment of diseases. Pharmocotherapy is used in the treatment of clients in all of the healthcare settings rather than being primarily used just in the critical care setting. Cognitive Level: Comprehension 4. The client s allergies. Rationale: The nurse would review the client s allergies as part of the client s medical history prior to administering a drug. This will help the nurse anticipate potential problems with the drug and take appropriate action. Options (b), (c), and (d) are not correct. The client s occupation, family history, and financial status would not affect the administration of the drug. 5. The generic medication has a different bioavailability than the brand name medication. Rationale: The pharmacist would recommend a trade name medication rather than a brand name medication because the trade name medication has a different bioavailability or onset of action. Generic name medications are often difficult to remember. Options (a), (c) and (d) are not

2 correct. Clients are much more likely to remember the trade name for the medication. Generic medications are often less expensive for the client to purchase. Generic medications are readily available to the client from a variety of manufacturers. 6. Allow the client drug treatment without adverse effects. Make inexpensive drug therapy available to the client. Allow the client to have drug therapy with few or no food interactions. Provide a predictable client response to the drug therapy. Rationale: The goals of pharmacotherapy are to provide the most ideal drug treatment for the client. This includes treatment that is accessible and affordable. The drug has minimal or no interaction with foods or other drugs. There are no adverse effects from the drug. The response to the drug is predictable with a rapid response when taken. Option (a) is not correct. Drug therapy does not always cure the client s health issues and may be taken to control symptoms without a cure. Nursing Process: Teaching and Learning 7. Therapeutic classification. Rationale: The therapeutic classification is used to identify drugs according to what condition is being treated. Options (a), (c) and (d) are not correct. The pharmacologic classification is used to identify drugs by their action. The prototype drug is used to help learners understand drug classes. There is one drug chosen to represent the group of drugs and other drugs are compared to this drug. The generic name is one name for a drug. It is not a drug class. 8. Diuretic. Rationale: Diuretics are used to relieve swelling in clients with excess body fluids. The diuretic lowers plasma volume and this reduces the swelling. Options (b), (c), and (d) are not correct. Vasodilators dilate or enlarge the diameter of peripheral blood vessels. Calcium channel blockers affect the force of the heart contractions. Adrenergic antagonists (or blockers) help control blood pressure by affecting the body s response to stress. 9. Compare the drugs to a drug prototype. Rationale: The drug prototype allows the learner to organize the drugs and then compare the drugs to the drug prototype. The drug prototype is the representative drug for the class. The information for the prototype can be generalized to the drugs in that particular class. Options (b), (c), and (d) are not correct. The chemical names are very lengthy and difficult to remember. The

3 generic names are easier to remember but can still be difficult to memorize. Trade names are easier to remember but there are numerous names for the same drug. This can be difficult for the learner to remember. 10. The pharmaceutical company has exclusive rights, typically for 5 years. Rationale: The pharmaceutical company has exclusive rights to the drug for 5 years. This can be extended for 3 more years under certain circumstances. Options (a), (c), and (d) are not correct. There is only one chemical name for the drug. Other pharmaceutical companies cannot produce alternative generic drugs as long as the original pharmaceutical company has exclusive rights. Generic medications in many cases are just as effective as trade name medications. Nursing Process: Teaching and Learning ANSWER KEY Chapter 2 NCLEX-RN Review 1. Safeguard the effectiveness and security of drugs. Rationale: The FDA requires that drug manufacturers demonstrate both the safety and effectiveness of pharmaceutical products. Options (a), (c), and (d) are incorrect. All drugs have potential reactions and adverse effects. Many factors determine the cost of a drug, and newly approved drugs may be the most expensive and not fully covered by health care insurance plans. Not all drugs have been tested in diverse populations, and women, minority ethnic groups, children, and older adults are often underrepresented in drug research studies. Client Need: Safe, Effective Care Environment 2. Phase 2. Rationale: Phase 2 of the clinical investigation relies on studying clients with the disease to be treated. Options (a), (c), and (d) are incorrect. Phase 1 studies use small groups of healthy subjects. Phase 3 studies use large numbers of subjects with the condition being treated by the drug. Phase 4 is considered post-marketing surveillance after the drug has been approved. Client Need: Safe, Effective Care Environment 3. Clients who have the disease the drug is designed to treat. Rationale: Drugs are tested on clients who have the disease the drug is designed to treat. This occurs in Phase 2 and Phase 3 of the drug research. During Phase 3 the drug will be tested on clients who also have chronic diseases. Children and pregnant women are often not included in drug trials. Options (a), (c), and (d) are incorrect. Drug testing is seldom performed on children, women, or older adults. Although many drugs are tested using animals, effectiveness in animals

4 does not always verify that the drug will be effective in humans. Client Need: Safe, Effective Care Environment 4. All Schedule II drugs must be prescribed on a special order form. Rationale: Telephone orders are not permissible under federal law for Schedule II controlled substances. Options (a), (b), and (d) are incorrect. Refill prescriptions are usually not any more or less expensive than the original prescription. The number of listeners is irrelevant. Schedule II prescriptions must be prescribed on a special form. Insurance payment is not the issue with the telephone refill for schedule II drugs. Client Need: Safe, Effective Care Environment 5. With a high potential for abuse or dependency. Rationale: The more likely a drug s potential for abuse and dependency, the stricter the regulation to control access to the substance. Options (b), (c), and (d) are incorrect. The cost and production difficulty do not influence the degree of regulation. Adverse effects and drug or food interactions do not dictate the level of regulatory control. The length of time taken to confirm that a drug is effective does not affect the degree of regulation. Client Need: Safe, Effective Care Environment 6. The Food and Drug Administration can give pharmaceutical companies approval before all testing in Phase 3 is complete. Rationale: The Food and Drug Administration can give early approval during Phase 3 of the clinical trial. This is an exception granted to drugs used to treat serious illness such as cancer and HIV. Options (a), (b), and (c) are not correct. The preclinical phase is not bypassed in any case. All drugs are subject to testing. Preclinical research includes cells and animals in the laboratory setting. This stage is not bypassed since many problems with drugs are identified in this stage. Client Need: Safe, Effective Care Environment 7. Require all drugs sold in the United States conform to standards. Rationale: Regulations based on information in the United States Pharmacopeia-National Formulary requires all drugs conform to standards or risk being charged with misbranding the drugs. Options (a), (c) and (d) are not correct. The USP label is recommended but not required at this time. There is currently a voluntary program for labelling herbal remedies with a label containing the ingredients. The Food and Drug Administration approve drugs. This does not involve the United States Pharmacopeia-National. Client Need: Safe, Effective Care Environment

5 8. The FDA approves all drugs before they are marketed in the United States. Rationale: The FDA is responsible for drug safety, security, and efficacy in the United States; thus, all drugs must be approved by the FDA. Options (a), (b) and (c) are not correct. The FDA does not provide funding for drug research. Funding is often recovered after the drug is released by giving the pharmaceutical company exclusive rights to sell the drug for 5 years. Currently herbal and dietary supplements are not tested. The FDA does regulate tobacco and tobacco cessation products. It does not test tobacco or tobacco cessation products. Client Need: Safe, Effective Care Environment Nursing Process: Teaching and Learning 9. As a control group in Phase 2 of the drug trial. Rationale: The placebo is given so the researchers can compare the effectiveness of the study drug with a placebo that contains no drug. It is a non-treatment inert substance with no action. Options (a), (b), and (d) are not correct. Placebos are not administered to animals. The placebo is not given in Phase 1. Phase 1 consists of administering the drug to healthy individuals. The placebo has no action so there can be no drug-drug interaction. Client Need: Safe, Effective Care Environment Nursing Process: Teaching and Learning 10. A prescription drug is prescribed for a specific health problem. Rationale: Prescription drugs require an assessment by a healthcare provider. This allows the healthcare provider to identify health issues that might otherwise not be identified. The healthcare provider can prescribe drugs that are specific to the client s health issue. Options (a), (b) and (d) are not correct. There may still be drug interactions depending on the drugs the client is taking. Side effects can still be an issue. However the healthcare provider can be certain the client is aware of the side effects. Over-the-counter and prescribed drugs are both readily available to the public. Cognitive Level: Client Need: Nursing Process: ANSWER KEY Chapter 3 NCLEX-RN Review 1. An elderly person. Rationale: The elderly person will have altered drug metabolism due to decreased hepatic enzyme action from aging. Options (a), (b), and (c) are incorrect. All of the other clients can be expected to have full functioning drug metabolism. 2. Decreased absorption.

6 Rationale: Peristalsis is the wavelike muscular contraction that pushes food into the stomach and helps to mix stomach contents. An increase in this activity would decrease the time that drugs would remain in the GI system and therefore decrease absorption. Options (a), (b), and (d) are incorrect. Excretion for most drugs occurs mostly through the kidneys, lungs, and glands. Peristalsis would not reduce excretions of medications. A delay in peristalsis would prolong absorption time, and peristalsis is not involved in the distribution of drugs to their target sites. 3. I can expect this medication to help my nasal drainage quickly. Rationale: Inhaled drugs produce an immediate therapeutic response. Options (a), (b), and (d) are incorrect. Inhaled medication can be used at any time during the day and is not restricted to the morning. Doses for inhaled drugs are small compared with orally ingested medications, and because these drugs go directly to the lung surface area and are readily absorbed, very little of the substance is lost due to metabolism. Cognitive Level: Application 4. Increase. Rationale: The length of time a drug concentration remains in the therapeutic range is its duration of action. Clients with hepatic impairment do not effectively metabolize drugs, which increases the duration of action. Options (a), (b), and (c) are incorrect. In clients with hepatic disease, the duration of action most likely will increase, since drug metabolism is impaired. Although the duration of action is extended, the effects of the drug are not improved. Client Need: Safe, Effective Care Environment 5. The effects of aging on metabolism. Rationale: Hepatic enzyme activity is usually decreased in elderly clients, which causes a prolonged drug effect. Options (b), (c), and (d) are incorrect. Drugs with short half-lives typically do not extend the drug effect. The minimum effective drug concentration is the amount of drug needed to generate the therapeutic effect. First-pass effect tends to decline with age. However, more important is the fact that injections (parenteral medications) do not undergo the first-pass effect. Client Need: Safe, Effective Care Management 6. The medication is excreted in your saliva and you can taste the medication. Rationale: Some drugs are excreted through the salivary glands and produce a taste during excretion. Options (b), (c), and (d) are incorrect. Although many oral drugs are absorbed in the intestinal tract, this does not account for peculiar tastes. This is not a genetic variation. This phenomenon can occur in any client. The blood brain barrier refers to a group of cells in the

7 brain that protect the brain. These cells prevent certain toxins and other substances from entering the central nervous system. Client Need: Safe, Effective Care Management 7. The drug level is appropriate to exert therapeutic effects. The nurse will need to continue monitoring, because each client response to a drug is unique. Rationale: A therapeutic drug level that is in the accepted range indicates that the drug is at a minimally effective concentration but not at a toxic level. Because each client response to a drug is unique, the nurse should continue monitoring the client throughout the drug s use. Options (a), (c), and (e) are incorrect. Because individual client responses to drugs can be highly variable, adverse effects, toxicities, or even no effect may occur at levels within the therapeutic range. For that reason, the drug dose may need to be adjusted throughout therapy. Therapeutic effectiveness of a drug depends on many factors, and the therapeutic range of a drug is the level between minimally effective and toxic levels. It is not an indicator of how effective a drug will be in treating an individual condition. 8. Administer the capsule whole with water or food. Rationale: An extended release medication cannot be crushed or otherwise altered. This would release the medication immediately and could cause toxic effects. Options (a), (c) and (d) are not correct. The capsule cannot be opened and the contents administered either with or without food. The capsule cannot be crushed prior to administration. 9. Ensure the medication is at room temperature. Rationale: The nurse would make certain the medication is at room temperature prior to administering the medication. Otic medications that are too cool can cause dizziness or nausea. Options (a), (b), and (c) are not correct. The nurse would not cool the medication in a refrigerator prior to administering. The nurse would not crush a pill since otic medications are dispensed as ear drops. The nurse would not irrigate the ear with cool liquid as this can cause dizziness or nausea. 10. The medication will take longer to absorb if I eat fatty foods first. Rationale: Fatty foods will cause GI motility to decrease and therefore slow drug absorption. Most drug absorption takes place in the small intestine. Slower motility allows more contact with acid gastric and enzymes. Options (a), (b), and (d) are not correct. Grapefruit juice is known to interfere with the absorption of some medications. The client would take the medication with

8 food and not wait. Waiting will allow the stomach to empty. Taking a medication on an empty stomach generally increases drug absorption. However certain medications have to be taken with food due to gastric irritation and other side effects. ANSWER KEY Chapter 4 NCLEX-RN Review 1. If I take more of this medication, I ll have a better response. Rationale: Although taking a larger dose of a medication usually results in a greater therapeutic response, the response also depends on the drug s plasma concentration. If a toxic level is reached from too large a dose, the drug will have adverse effects instead of a better therapeutic response. Options (a), (c), and (d) are incorrect because they are true statements. The liquid form of a drug will be absorbed faster than its tablet form. Food decreases the absorption rate of most drugs. Clients should always consult a health care provider if unexpected adverse effects develop. 2. The medication is probably safe. Rationale: Therapeutic index is the ratio between the therapeutic dose and the toxic dose of a drug, and is used as a measure of the relative safety of the drug. The higher the therapeutic index is, the greater the safety of the drug. Options (b), (c), and (d) are incorrect. A high therapeutic index does not indicate the need for additional monitoring. Blood levels may be indicated in medications with either or high or low therapeutic index. A high degree of safety does not signify the effectiveness of the drug. Client Need: Safe, Effective Care Management 3. The amount of a drug administered and the degree of response it produces. Rationale: A dose-response curve is a graphic representation that shows the relationship between the amount of a drug administered and the extent of the response it produces. Options (b), (c), and (d) are incorrect. A dose-response curve does not illustrate of action of a drug. Serum drug levels must be measured to determine the peak level. It is unique to each client, and the doseresponse curve only represents a maximum (toxic) dose level. Cognitive Level: Remembering Client Need: Safe, Effective Care Environment 4. Toxicity. Rationale: The TD50 measures the median toxicity dose. This information indicates the dose that will produce a given toxicity in 50% of a group of clients. Options (a), (b), and (c) are incorrect. Effectiveness, dose response, and receptor subtypes are not represented by the TD50 level. Cognitive Level: Remembering

9 5. The new medication is more potent. Rationale: Potency refers to the amount of medication needed to produce a desired effect. Options (b), (c) and (d) are not correct. The therapeutic index refers to the safety of the medication and the dose needed to provide safe medication therapy. A higher lethal dose means the dose that could prove fatal in animal trials. The margin of safety is an index of a medication s safety and effectiveness. A lower margin of safety means the medication is considered to have a higher risk of lethality or negative outcome for the client. Nursing Process: Planning 6. A dose that promotes a therapeutic response in 50% of clients. Rationale: The mean effective dose is the average or standard dose. It the dose that will provide a certain therapeutic response in 50% of clients. Options (b), (c), and (d) are not correct. The client may have side effects when taking a dose that is the mean effective dose. The medication may or may not be safe for clients over the age of 50 years. The medication should not produce toxic effects if taken at the mean effective dose. Nursing Process: Planning 7. It is possible the target receptors for this medication are full. Rationale: One explanation for this occurrence is the client s receptors for this medication are full. This is usually temporary and will reverse when the medication leaves the receptor. Options (a), (b), and (c) are not correct. There is no indication the medication is outdated. Higher doses of the same medication are just as potent. Exceeding the safe dosage of the medication can cause adverse or toxic effects. Client Need: Safe, Effective Care Management 8. The medication will kill cancer cells and help me get better. Rationale: Efficacy refers to medication effectiveness. In this case the medication will kill cancer cells. Options (a), (c), and (d) are not correct. The potency refers to the amount of medication that is needed to be effective. In this case the drug is more potent than other medications. Efficacy does not involve how the medication directly acts on the cancer cells, whether binding with the cells or competing for receptor sites. Cognitive Level: Understanding Client Need: Safe, Effective Care Management 9. Compete with the narcotic for receptor sites. Rationale: The medication used to reverse the narcotic is an antagonist. This medication will compete with the narcotic for receptor sites. By reducing the receptor sites the effects of the

10 narcotic are minimized. Options (b), (c), and (d) are not correct. Agonists can activate a receptor site. Intrinsic activity refers to drugs that bind to a receptor site and cause a strong action. The second messenger is a message released once the receptor is occupied. This message causes chemicals to be released. Cognitive Level: Understanding Client Need: Safe, Effective Care Management 10. You can still have adverse effects but this is not related to your previous medication. Rationale: Any medication can cause adverse effects. The risk goes up if the dosage is increased. Options (a), (b), and (d) are not correct. The type of disease does not influence the risk of adverse effects. The client is not at higher risk for adverse effects since the drug was changed rather than increasing the dosage. Not every medication has adverse effects. This is on an individual basis rather than based on all experiences with a particular medication. Client Need: Safe, Effective Care Management ANSWER KEY Chapter 5 NCLEX-RN Review 1. Ask the client to describe the reaction further. Rationale: Collecting additional information will provide the prescriber with knowledge about the type and severity of the reaction to that specific drug, and will assist in determining the appropriateness of the order. Options (b), (c), and (d) are incorrect. The nurse should gather additional information from the client or family member before notifying the prescriber. A medication is never administered to a client when allergic sensitivity is suspected until further investigation into the type and severity of the reaction has been completed. Although documentation of the event may be in the client s medical record, the reaction may not have been documented or may have happened after the last health care visit. 2. Perform a thorough assessment prior to administering the medication. Rationale: The nurse would perform a thorough assessment prior to administering the medication. This provides a baseline of information the nurse can refer to in case the client has changes in assessment after administering the medication. Options (b), (c), and (d) are incorrect. Although adverse effects are sometimes noted after the first dose, they may occur at any time during drug administration. Adverse effects can occur with any administration route. Adverse effects can occur at any time after the medication is administered. While most adverse effects occur minutes to hours after administering the medication some medication cause adverse effects days or weeks after administering the medication. Nursing Process: Planning

11 3. Increase fluid intake to promote adequate hydration. Rationale: Promoting hydration may dramatically reduce the risk of renal damage produced by drug therapies. Options (a), (b), and (c) are incorrect. Clients receiving drugs that cause phototoxicity are taught to avoid direct sunlight. The consumption of potassium-enriched foods will not reduce the risk of drug-induced nephrotoxicity, and neither will avoiding alcohol consumption. Nursing Process: Teaching and Learning 4. Urticaria. Rationale: Urticaria or hives, with raised, itchy areas of skin, is usually a sign of an allergic reaction. Options (a), (b), and (d) are incorrect. Angioedema is a notable swelling around the eyes and lips, and sometimes of the hands and feet, which occurs beneath the skin instead of on the surface. SJS is characterized by a flulike period of fever, sore throat, and headache followed by the sudden development of circular lesions that cover the majority of the skin. Phototoxicity occurs when a drug renders the skin susceptible to damage by sunlight. 5. A decrease in red blood cells, white blood cells, and platelets. Rationale: The function of the bone marrow is to produce blood cells. When drugs cause bone marrow toxicity, the condition manifests as a decrease in all blood cell types. Options (a), (c), and (d) are incorrect. Muscle and bone pain are most often associated with muscle toxicity. Weight gain, swelling, and shortness of breath are consistent with cardiac toxicity. Client reports of problems with hearing are consistent with damage to cranial nerve eight. This is a form of neurotoxicity. 6. Right upper quadrant pain and anorexia. Rationale: Right upper quadrant pain and anorexia are the vague symptoms often associated with drug-induced liver damage. Options (a), (b) and (d) are incorrect. Black, furry tongue or other infections are not related to liver damage. A sudden drop in BP is orthostatic hypotension. Unusual and uncontrolled movements are neurologic-related effects. 7. Do not take garlic supplements while taking anticoagulants. Rationale: Garlic can increase the risk of bleeding when taken with anticoagulants. Options (a), (c) and (d) are not correct. St. John s Wort can increase the effectiveness of anticoagulants. Client taking anticoagulants should not take St. John s Wort. Gingko can cause an additive effect

12 with the anticoagulants and affect blood levels of the anticoagulants. Milk does not bind with anticoagulants. It does bind with other drugs such as etidronate (Didronel). Client Need: Safe, Effective Care Management Nursing Process: Teaching and Learning 8. Potassium. Rationale: The client is taking both furosemide and digoxin. Furosemide causes a decrease in potassium levels because of potassium excretion in the kidneys. The low potassium levels increase the cardiotoxicity of digoxin. Options (b), (c), and (d) are not correct. Sodium, chloride and calcium are not excreted by furosemide. These electrolytes are not affected by interactions between furosemide and digoxin. Client Need: Safe, Effective Care Management 9. Let your healthcare provider know about all medications you are taking. Rationale: All clients, especially a client who may be pregnant, should let the healthcare provider about all medications the client is taking. Options (a), (b), and (d) are not correct. Not all medications are safe during pregnancy. The number of pregnant females is low compared to the population that will be taking the medication. There is no need for a monthly pregnancy test unless the client is taking a medication that is known to cause severe birth defects. Not all medications will cause birth defects. This is determined when the medication is being tested prior to being marketed. The client should assume the medication is not safe if there is no documentation proving the medication is safe. Client Need: Safe, Effective Care Management 10. If I forget a dose of this drug, I should double up to get back on schedule. Rationale: The nurse should evaluate the drug-related teaching. There is no drug for which a nurse would advise the client to take a double dose if forgotten. Clients who experience neurotoxicity may suffer mental confusion, hallucinations, or changes in sensorium. Options (a), (c), and (d) are incorrect. Driving could be hazardous and should be avoided until the effects of the drug are fully known. The development of slurred speech and tingling of the hands and feet may be indicators of neurotoxicity. Client Need: Safe, Effective Care Management ANSWER KEY Chapter 6 NCLEX-RN Review 1. The client became dizzy and fell after taking a medication. The client experienced a side effect from the medication and fell. The client may have been seriously injured. This meets the criteria for a sentinel event. Options (a), (c), and (d) are not

13 correct. The healthcare provider can change medications for the infection based on client needs. This is not an event that could or did cause injury or death. The pain relief is an expected outcome for the medication. The client can decline medication as a client right. This does not meet the criteria for a sentinel event. Cognitive Level: Understanding Client Need: Safe, Effective Care Environment Nursing Process: Assessing 2. The nurse would clarify the order with the healthcare provider. Rationale: The healthcare provider is responsible for ordering the medications and changing the dose as indicated. Options (b), (c), and (d) are not correct. The nurse would not rely on another nurse to clarify the order. The nurse would not rely on the pharmacist to address the medication order. The nurse cannot adjust the medication dosage since this is outside the scope of practice for the nurse. Client Need: Safe, Effective Care Environment 3. Have all prescriptions filled at one pharmacy. Rationale: Pharmacies maintain records of medication dispensed to individuals. If a pharmacist can review the client s drug history on each subsequent visit, serious potential drug interactions may be identified. Options (a), (c), and (d) are incorrect. Insisting on acquiring a brand name drug rather than a generic does not ensure the safety of a medication. For safety reasons, drugs are dispensed in containers that are sometimes difficult to open. Unless there is a specific reason (such as impaired hand dexterity), medications should be stored in their original safety bottles. Information found on the Internet may vary in quality and may be provided by non-health carerelated sources. When in doubt, the prescriber or pharmacist can provide the most accurate information about expected effects. 4. Verify the order and double-check the medication label. Rationale: The nurse should always validate a questionable order when a client or a family member verbalizes concern. Options (a), (b), and (d) are incorrect. Medications purchased by a clinical agency vary in appearance depending on the manufacturer from which the drug is purchased, but the nurse should withhold the medication and then confirm that it is the correct drug as ordered before administering. If a client questions a change in medication or procedure, the nurse should verify the order and obtain validation from the prescriber. The nurse would not hold the medication unless there is an issue with the order or the client declines the medication. Client Need: Safe, Effective Care Environment 5. Assess the client and monitor for adverse effects. Rationale: The nurse s first priority is always the client. The nurse first should determine the

14 client s baseline assessment data in order to determine if any adverse effects are occurring. Options (b), (c), and (d) are incorrect. The health care provider should be notified of the medication error; however, it is also important to report the client s assessment data at the same time. All health care agencies have reporting mechanisms for drug errors, and the nurse will be responsible for completing this process after assessing the client and notifying the provider. If the client experiences an adverse reaction to the drug, further assessment will be needed before confirming that the drug itself, rather than client variables (e.g., allergy), was behind the reaction before filing an Adverse Drug Reaction report. Client Need: Safe, Effective Care Environment 6. Let me know when you are ready, and I will then return with your medicine. Rationale: Returning when the client is available ensures that the client takes the medication and offers opportunity for the nurse to assess for effects or provide teaching related to the medication. Options (a), (b), and (d) are incorrect. A nurse must ensure that the medication is taken by the client. By leaving the medication at the bedside or with visitors, the nurse will not know with certainty that the client took the medication. When a client refuses a medication, the nurse should document reasons for the refusal so that appropriate follow-up may be carried out. In this situation, the client did not refuse the medication but was not available to take it at that moment. Client Need: Safe, Effective Care Environment 7. Provide additional instruction about the medication. Rationale: A competent client has the right to refuse medication. The nurse does have an obligation to ensure the client is fully informed about the medication before declining the medication. Option (a), (b), and (d) are not correct. The nurse would not insist the client take the medication since this could be considered a violation of client rights. The nurse would not involve the family in administering the medication. It is the nurse s responsibility to administer the medication. The nurse would notify the healthcare provider only if the client is fully informed and still refuses the medication. Client Need: Safe, Effective Care Management 8. Ask the healthcare provider to prescribe a medication taken once a day. Rationale: Quite often clients will forget to take a medication. This particularly true when the medication is taken several times a day. Changing the dose to once a day will help the client adhere to medication therapy. Options (a), (b), and (d) and not correct. Putting the medication times on a calendar will not necessarily help the client remember to take the medications. Family members may not always be available to remind the client to take medications. Telling the client how important medication adherence is will not help the client to remember to take the medications.

15 Client Need: Safe, Effective Care Management 9. Crushing medications that are sustained release. Opening medications prior to entering the client s room. Preparing medications in a busy room. Documenting medications at the end of the shift. Rationale: Medications that are sustained release cannot be crushed. If crushed, the entire dose of medication will be immediately released resulting in a toxic dose. Medications must be opened at the bedside in order to prevent a medication error. The nurse will able to readily identify the medication and ensure the medication and dosage is correct if opened immediately before administering. The client will also be able to verify the medication as well. There is an increase in medication errors if medications are prepared in an area where the nurse is interrupted by noise and activity. Medications must be documented as they are given. The nurse may forget what medications were given or document incorrectly. Option (e) is not correct. Calculating medication doses helps prevent medication error rather than contributing. The nurse is responsible for ensuring the client is receiving a safe dose of medication. Cognitive Level: Remembering Client Need: Safe, Effective Care Management 10. Failure to fully assess the client. Rationale: The nurse is responsible for assessing the client prior to any intervention. The nurse did not assess the client s allergies prior to administering the medication. Options (a), (c), and (d) are not correct. The nurse administered the medication ordered by the healthcare provider. The nurse did not need to clarify the order prior to administering the medication. The medications may not be sound alike medications. The nurse failed to gather sufficient information prior to administering the medication. Client Need: Safe, Effective Care Management ANSWER KEY Chapter 7 NCLEX-RN Review 1. Herbal therapies have been standardized in order to provide consistency for the consumer. Rationale: Herbal therapies have not been fully tested through research and the benefits and risks are not fully known. Options (b), (c), and (d) are not correct. There may be predictable and accurate results from some of the herbal therapies. There are known drug-herb interactions. Herbal therapies produce predictable effects in many cases. Herbal therapies may be less expensive than traditional therapies depending on the herb and the medication. Client Need: Safe, Effective Care Environment 2. Take the smallest amount possible when starting herbal therapy.

16 Rationale: It is best to advise the client to take small amounts of a new supplement to determine any initial intolerance. Options (a), (b), and (d) are incorrect. St. John s Wort is not known to cause restlessness or agitation. It does cause sedation. There is no indication the client will experience bleeding or bruising while taking St. John s Wort. Allergic reactions are possible with natural supplements. Clients should be taught to read the label carefully and avoid any supplement that contains any known allergy-provoking substances. Nursing Process: Teaching and Learning 3. An herbal tea can be made by soaking dried herbs in hot water for a short time. Rationale: Herbal teas are made by soaking herbs in hot water for five to ten minutes before drinking. Options (a), (b), and (c) are not correct. A tincture is made by extracting the herb with alcohol. Herbs can be marketed in pill form or as an ointment. Cognitive Level: Remembering 4. Herbal supplements are readily available in many supermarkets. Manufacturers of herbal supplements aggressively market their products. Herbal supplements are thought to be less expensive. Rationale: Herbal products are readily available in most supermarkets. They are much easier to obtain than prescription medications. Manufacturers aggressively market their products and at times make claims that are not true. Often people consider herbal products to be cheaper than prescription medications. This is especially important for elderly clients who are living on a fixed income. Options (d) and (e) are not correct. Herbal supplements are not always safe and effective. There are numerous side effects and interactions with medications. Herbal products may not be effective as well. Cognitive Level: Understanding Client Need: Safe, Effective Care Environment 5. USP verified dietary supplement mark. Rationale: The USP verified dietary supplement mark is awarded to dietary supplements that pass verification processes. The mark represents that USP has tested the supplement to verify that the label accurately reflects the product in the bottle and that the supplement does not contain harmful levels of contaminants. Options (b), (c), and (d) are incorrect. A DEA number is assigned to a health care provider and allows the provider to write prescriptions for controlled substances such as a narcotic. The FDA does not control herbal supplements, and this code does not exist. U.S. Customs is not responsible for ensuring that herbal supplements are pure. Client Need: Safe, Effective Care Environment 6. May have age-related changes in liver or kidney function. Rationale: Changes in liver or kidney function in the older adult may lead to changes in

17 metabolism or excretion for herbal as well as synthetic medications. Options (a), (b), and (c) are incorrect. Older adults are no more likely to have difficulty taking herbal medications or to spend more money on these products than the younger adult population. These difficulties are clientspecific at any age. Due to aggressive marketing campaigns by the herbal and dietary supplement industry, all age groups are likely to hold unrealistic expectations for herbal products. 7. Green tea will interfere with warfarin and make you more likely to have a clot. Rationale: Green tea is known to interfere with warfarin and decrease anticoagulant effects. This means it takes less time to form a clot in the client s body, making the client more likely to have a clot. Options (a), (b), and (c) are not correct. Green tea has many benefits but it is not safe for this client. The USP label indicates the green tea is pure. Green tea is not known to cause sedation. Client Need: Safe and Effective Care Environment 8. Toxic effects in the liver. Rationale: Comfrey when taken with acetaminophen can cause toxic effects in the liver (hepatotoxicity). Options (b), (c), and (d) are not correct. The comfrey does not increase acetaminophen effects. Comfrey and acetaminophen together do not affect blood glucose or clotting time. Cognitive Level: Understanding Client Need: Safe and Effective Care Environment 9. Chondroitin and glucosamine may help because they are both needed for healthy cartilage. Rationale: Chondroitin and glucosamine are necessary for cartilage growth and maintenance. Supplements may help relieve the effects of arthritis such as joint pain and stiffness. Options (a), (b), and (c) are not correct. The use of chondroitin and glucosamine can be legitimate in clients with joint problems. These are naturally occurring substances but cannot be supplemented through the diet. There is some evidence the two substances can provide some relief from joint problems. 10. Instruct the client to stop taking the ginseng. Rationale: The client s digoxin level is too high. Ginseng can cause toxic effects when taken with digoxin. Options (a), (c), and (d) are not correct. The nurse would assess the fatigue and stress levels after addressing the high digoxin level. The client s elevated digoxin level indicates he/she is taking the digoxin.

18 ANSWER KEY Chapter 8 NCLEX-RN Review 1. When possible, drug therapy is postponed until after pregnancy and lactation. Rationale: It is recommended that all drugs be avoided as much as possible during pregnancy due to the potential effect on the fetus or infant. Options (a), (c), and (d) are incorrect. Drugs that are available OTC may also be hazardous and may affect the unborn fetus and nursing infant. Drugs used for treating medical conditions such as asthma, hypertension, diabetes, and epilepsy should be continued throughout pregnancy after review by the health care provider for the safety of both mother and infant. There must be close monitoring during this time. In such cases, the benefits may outweigh the risks. The woman should consult with her health care provider regarding any drugs taken during pregnancy and lactation. 2. Category X. Rationale: Drugs in category X are clearly contraindicated because they pose serious risk to the fetus. Options (a), (b), and (c) are incorrect. Category A drugs are safe for the pregnant woman because they demonstrate no risk of injury to the unborn fetus. Category B consists of drugs that may be given to the mother during pregnancy. Drugs in category C represent those for which there is insufficient evidence that the drug is either safe or dangerous to the fetus, and these drugs will be evaluated by the provider to determine if the benefit outweighs the risk. 3. Highly lipid-soluble drugs cross the placental membrane more easily than do low lipids. Rationale: Although multiple factors affect the transfer of drugs across the placenta, highly lipidsoluble drugs will cross the placental barrier more easily than will water-soluble drugs. Options (b), (c), and (d) are incorrect. Small molecules such as alcohol easily cross the placental barrier, whereas larger molecules are slower to cross. When drugs are highly protein-bound, they are too large to cross the placental membrane to 2 weeks. Rationale: Weeks 1 to 2 of the first trimester are known as the preimplantation phase. Before implantation, the developing embryo has not yet established a blood supply with the mother. This is sometimes called the all-or-none period because exposure to a teratogen either causes death of the embryo or has no effect. Drugs are less likely to cause congenital malformations during this period because the baby s organ systems have not yet begun to form. Options (b), (c), and (d) are incorrect because the embryonic period is 3 to 8 weeks post-conception. During the

19 embryonic period there are rapid development of internal structures and maximum sensitivity to teratogens. Teratogenic agents taken during this phase can lead to structural malformation and spontaneous abortion. The specific abnormality depends on which organ is forming at the time of exposure. Cognitive Level: Understanding Nursing Process: Planning 5. I can take acetaminophen as long as I take the lowest effective dose. Rationale: Acetaminophen is generally safe for breast feeding mothers. Options (b), (c), and (d) are not correct. The higher the dose of medication, the more medication that is secreted into the breast milk. There are safe medications for lactating mothers, but this needs to be cleared by the healthcare provider. The form of medication does not affect how much crosses into the breast milk. 6. Drugs remain longer in the gastrointestinal tract, leading to extended time for absorption. Rationale: Increased levels of progesterone cause a decrease in gastric tone and intestinal motility, resulting in delayed gastric emptying. This leads to extended time for drug absorption. Options (a), (b), and (d) are incorrect. The increased maternal heart rate increases the amount of drug delivered throughout the body. There is more free water available in the body. This means there is more free drug available due to diluted plasma proteins. The blood flow to the kidneys is increased which means the drug is excreted more quickly. Cognitive Level: Understanding 7. Check the order and administer the medication using the five rights. Rationale: Insulin is shown to be safe during pregnancy. The nurse would check the order and administer the medication in a safe manner. Options (b), (c), and (d) are not correct. There is no indication for clarifying the order with the pharmacist or healthcare provider. The nurse should teach the client about insulin, but there is no indication for the client declining the medication based on safety. Client Need: Safe, Effective Care Management 8. Accutane is associated with damage to fetal brain. Rationale: Accutane has a risk category X which means it is known to cause serious damage to the fetus. The drug is contraindicated during pregnancy. Options (a), (b), and (c) are not correct. There are no circumstances where Accutane is safe during pregnancy. Client Need: Safe, Effective Care Management

20 9. All oral contraceptives enter the breast milk and should not be used. Rationale: Oral contraceptives enter the breast milk and can affect the infant. Options (a), (b), and (d) are not correct. Oral contraceptives are effective during lactation. Oral contraceptives cannot be started at six months if the mother is still breastfeeding. Estrogen is to be avoided during lactation. Client Need: Safe, Effective Care Management 10. Newborns of mothers who use marijuana may experience withdrawal. Rationale: Newborns of mothers who use marijuana may experience excessive crying and trembling. These are signs of withdrawal. Options (a), (b), and (c) are not correct. Not all street drugs cause miscarriage. Some have an increased risk such as cocaine. Amphetamines can cause heart defect and cleft lip. However marijuana is not known to cause these birth defects. Client Need: Safe, Effective Care Management ANSWER KEY Chapter 9 NCLEX-RN Review 1. Slower gastric motility in young children will keep the drug in the stomach longer. Rationale: In young children, delayed gastric emptying may cause oral medications to remain in the stomach longer. This results in slowed absorption and an increased risk for adverse drug reactions. Options (b), (c), and (d) are incorrect. Prior to age 6 months, the child s immature liver produces very small levels of plasma proteins. Drugs that normally bind to plasma proteins will now be present as free drugs in the system, increasing drug distribution and increasing the risk for adverse effects. Drug excretion is not efficient in young children and reduced renal clearance means lower doses of medication. Careful renal monitoring is required when nephrotoxic medications are administered. The blood-brain barrier is not well developed at birth, and drugs can penetrate the CNS easily, causing heightened effects. Nursing Process: Planning 2. Vastus lateralis. Rationale: The vastus lateralis muscle mass is the most developed in infants and young children and therefore most appropriate for IM injections. Options (b), (c), and (d) are incorrect. The deltoid, dorsogluteal, and ventrogluteal sites have very little muscle tissue available for injection and may have erratic blood flow, leading to decreased medication absorption. 3. Intramuscular (IM) injections in infants are absorbed slowly.