Introduction To Clinical Pharmacology 8th Edition by Marilyn Winterton Edmunds – Test Bank
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Sample Test
Chapter 3: Legal Aspects Affecting the Administration of
Medications
Edmunds: Introduction to Clinical Pharmacology, 8th Edition
MULTIPLE CHOICE
1. Which
medication is an example of a controlled substance?
|
a. |
Birth control pills |
|
b. |
An antibiotic |
|
c. |
Codeine |
|
d. |
A laxative |
ANS: C
Controlled substances include major pain killers (narcotics) and
some sedatives or tranquilizers that can be prescribed by someone with a
special license. Codeine is a Schedule II controlled substance.
DIF: Cognitive Level:
Remember
REF: Table 3-2 OBJ:
2
TOP: Controlled Substances
KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
2. Which
health care professional is licensed to prescribe controlled substances?
|
a. |
LPN/LVN |
|
b. |
Physical therapist |
|
c. |
Pharmacist |
|
d. |
Physician |
ANS: D
Federal and state laws make it a crime for anyone to possess
controlled substances without a prescription. Each state has a practice act
that lists which health care providers may dispense and write prescriptions for
controlled substances. Physicians may write prescriptions for controlled
substances.
DIF: Cognitive Level:
Remember
REF: p.
21
OBJ: 2
TOP: Controlled
Substances
KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
3. A
patient brings his multivitamins to the hospital and asks the LPN/LVN if he can
take them. Which is the nurse’s best response?
|
a. |
“Yes, but I must keep them
in the medication room.” |
|
b. |
“No, I have to obtain a
doctor’s order first.” |
|
c. |
“Yes, let me put them in
your bedside stand for you.” |
|
d. |
“Not until the pharmacist
adds them to your medication record.” |
ANS: B
Over-the-counter (OTC) medications do not require a prescription
for purchase, but a physician’s order is required before they may be taken in
the hospital. OTC medications may interact with a patient’s prescribed
medications. Therefore, the physician must be aware of all the meds the patient
is taking.
DIF: Cognitive Level:
Apply
REF: p.
22
OBJ: 3
TOP: Over-the-Counter
Medications KEY: Nursing Process
Step: Assessment
MSC: NCLEX: Physiological Integrity
4. Which
drug distribution system is commonly used when ordering medication in an
agency?
|
a. |
Multidose system |
|
b. |
Health care system |
|
c. |
Welfare system |
|
d. |
Ward stock system |
ANS: D
Each agency has its own way of ordering and administering
medications distributed to nurses. The floor or ward stock system is one of the
systems.
DIF: Cognitive Level:
Understand
REF: p. 26| Box 3-2
OBJ:
3
TOP: Drug Distribution
Systems
KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
5. Which
is a document that is considered to be a legal record and hospital property?
|
a. |
Kardex |
|
b. |
Medication card |
|
c. |
Armband |
|
d. |
Patient chart |
ANS: D
The patient’s chart is a legal record. It is the major source of
information about the patient and the care received while in the hospital. The
Kardex card is thrown away when the patient is discharged. It is not a legal
document.
DIF: Cognitive Level:
Remember
REF: p.
24
OBJ: 7
TOP: Patient
Charts
KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
6. What
should the nurse do first if a controlled substance is accidentally spilled or
contaminated?
|
a. |
Obtain another dose from
the narcotic control system. |
|
b. |
Document the occurrence in
the medication record. |
|
c. |
Clean up the spill and
notify the supervisor. |
|
d. |
Ask another nurse to cosign
the inventory record describing the situation. |
ANS: D
If the ordered dose is smaller than the dose provided (so that
some medication must be discarded), or if the medication is accidentally
dropped, contaminated, spilled, or otherwise made unusable and unreturnable,
two nurses must sign the inventory report and describe the situation.
DIF: Cognitive Level:
Understand
REF: p.
28
OBJ: 4
TOP: Controlled
Substances
KEY: Nursing Process Step: Assessment
MSC: NCLEX: N/A
7. As
the nurse is coming on duty to take over the day shift, the night nurse tells
the nurse that she has already counted the controlled drugs for the day shift.
What should the nurse do in this situation?
|
a. |
Do nothing; this is
standard procedure. |
|
b. |
Accept the keys and recount
the drugs. |
|
c. |
Recount the drugs with
another nurse. |
|
d. |
Count the drugs at the end
of your shift. |
ANS: C
At the end of each shift, the contents of the locked cabinet are
counted together by one nurse from each shift. A nurse who is willing to take
the word of another nurse from the previous shift, without verifying the count,
risks being held accountable for any shortages or discrepancies, and may be
found guilty of falsifying records. If you go along with her, you are
falsifying records.
DIF: Cognitive Level:
Apply
REF: p.
28
OBJ: 4
TOP: Narcotics
Control
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
8. What
is the missing component of the following medication order: Atropine 1 mg IV?
|
a. |
Frequency |
|
b. |
Indication |
|
c. |
Route |
|
d. |
Dilution |
ANS: A
Regardless of whether the prescription is for a hospitalized
patient or not, the order must contain the same information: patient’s full
name, date, name of drug, route of administration, dose, frequency, duration,
and signature of prescriber.
DIF: Cognitive Level:
Apply
REF: p.
29
OBJ: 5
TOP: Drug Orders KEY: Nursing
Process Step:
N/A
MSC: NCLEX: N/A
9. The
order reads, Theochron
200 mg PO qid. The nurse understands that this is which type of
medication order?
|
a. |
Priority |
|
b. |
Standing |
|
c. |
Flexible |
|
d. |
Indefinite |
ANS: B
Medication orders may be classed into one of four types. A
standing order indicates that the drug is to be administrated until
discontinued or for a certain number of doses.
DIF: Cognitive Level:
Apply
REF: p. 30 | Table 3-3
OBJ: 6
TOP: Drug Orders KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
10. Meperidine,
75 mg IV push, is ordered by the physician to be given stat. The nurse
understands that this is which type of order?
|
a. |
Standing |
|
b. |
Immediate |
|
c. |
Flexible |
|
d. |
Indefinite |
ANS: B
A stat order
is a type of medication order that is a one-time order to be given immediately.
DIF: Cognitive Level:
Apply
REF: p. 30 | Table 3-3
OBJ:
7
TOP: Types of Medication Orders
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
11. A
nurse has administered the wrong medication to a patient. Which is the
highest-priority nursing action at this time?
|
a. |
Document the occurrence in
the patient record. |
|
b. |
Notify the immediate
supervisor of the error. |
|
c. |
Complete an incident report
and submit it to the nurse manager. |
|
d. |
Evaluate the patient’s
condition and notify the physician. |
ANS: D
When it is discovered that an error has been made, the nurse
should immediately check the patient. The physician should be notified
promptly, and any orders the physician gives must be followed. The nurse
manager or charge nurse also needs to be notified at once.
DIF: Cognitive Level: Understand
REF: p.
31
OBJ: 8
TOP: Medication
Errors
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
12. Which
is the correct interpretation of the following order: Rx Epifrin 0.25% 2 gtt OU bid?
|
a. |
Two drops in both eyes
twice daily |
|
b. |
Two drops in the left eye
four times daily |
|
c. |
Two drops in the right eye
twice daily |
|
d. |
Two drops in both eyes four
times daily |
ANS: A
Drop(s) is written as gt (gtt) and is a common abbreviation used
in pharmacology. OU (oculus
uterque) means “each eye,” and bid means
“twice daily.”
DIF: Cognitive Level:
Analyze
REF: pp. 30-31 | Table 3-4
OBJ:
6
TOP: Common
Abbreviations
KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
13. A
nurse is taking care of an older adult patient with hypertension. He was
prescribed an antihypertensive medication; however, he has decided to use a
cheaper herbal product that he can buy over the counter and which he thinks
will lower his blood pressure. The patient tells this information to the nurse
in an interview. Which is the best response to this patient?
|
a. |
“That sounds good, but you
need to check your blood pressure often.” |
|
b. |
“There are several kinds of
over-the-counter medications to choose from that can work.” |
|
c. |
“You will not need a
prescription for over-the-counter medication, and it is cheaper.” |
|
d. |
“Herbal products are not
regulated for effectiveness in treating hypertension.” |
ANS: D
At present, herbal products are not regulated, standardized, or
tested for safety and effectiveness.
DIF: Cognitive Level:
Apply
REF: p.
22
OBJ: 6
TOP: Over-the-Counter
Medications KEY: Nursing Process
Step: Assessment
MSC: NCLEX: Physiological Integrity
14. A
patient is discharged from the hospital. To whom should all the medications the
patient was taking that are classified as controlled substances be given?
|
a. |
The patient at discharge |
|
b. |
The patient’s family at
discharge |
|
c. |
The hospital pharmacy after
the patient’s discharge |
|
d. |
Another hospital patient
after the patient’s discharge |
ANS: C
All controlled substances ordered for a patient but not used
while the patient is in the hospital go back to the pharmacy when the patient
is discharged.
DIF: Cognitive Level:
Apply
REF: p.
21
OBJ: 5
TOP: Controlled
Substances
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
15. Important
information is recorded in a patient’s hospital chart while the patient remains
in the hospital. When a patient is discharged, which is true regarding the
ownership of the patient’s chart?
|
a. |
The patient owns the chart,
but the hospital keeps the record. |
|
b. |
The chart is a record that
no one really owns. It is kept by the hospital. |
|
c. |
The chart is a legal
document that is owned by the state courts. |
|
d. |
The chart is a legal
document that is owned by the hospital. |
ANS: D
The chart belongs to the hospital. It is not the property of the
patient, the nurse, or the physician.
DIF: Cognitive Level:
Remember
REF: p.
24
OBJ: 3
TOP: Patient
Charts
KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
16. What
is the title of legislation passed in 2001 for health care workers?
|
a. |
Federal Food, Drug, and
Cosmetic Act |
|
b. |
Durham-Humphrey Amendment |
|
c. |
Kefauver-Harris Amendment |
|
d. |
Needlestick Safety and Prevention
Act |
ANS: D
In 2001, the Needlestick Safety and Prevention Act was
legislated to require hospitals to have programs to prevent needlestick
injuries, document them when they occur, and purchase safe equipment,
regardless of cost.
DIF: Cognitive Level:
Remember
REF: p. 31| Table 3-1
OBJ:
1
TOP: Drug
Legislation
KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
17. Which
is an example of a Schedule I controlled substance?
|
a. |
Morphine |
|
b. |
Lomotil (diphenoxylate with
atropine sulfate) |
|
c. |
Heroin |
|
d. |
Pentobarbital |
ANS: C
Heroin has no currently accepted medical use in the United
States and there is a lack of accepted safety guidelines for its use under
medical supervision. Morphine and pentobarbital are both Schedule II controlled
substances; Lomotil (diphenoxylate with atropine sulfate) is a Schedule V drug.
DIF: Cognitive Level:
Remember
REF: pp. 19-20 | Table 3-2
OBJ:
2
TOP: Controlled Substances
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
18. Enactment
of which major federal drug regulations required that new drug products be
proven both safe and effective
before they could be approved for sale in the United States?
|
a. |
Federal Food, Drug, and
Cosmetic Act (FD&C Act), 1938 |
|
b. |
Comprehensive Drug Abuse
Prevention and Control Act (Controlled Substances Act), 1970 |
|
c. |
Durham-Humphrey Amendment
to the FD&C Act, 1951 |
|
d. |
Kefauver-Harris Amendment
to the FD&C Act, 1962 |
ANS: D
Prior to 1962, manufacturers of new drug products were only
required to prove that their products were safe for marketing.
DIF: Cognitive Level:
Remember
REF: Table 3-1 OBJ:
1
TOP: Drug
Legislation
KEY: Nursing Process Step: N/A
MSC: NCLEX: Safe, Effective Care Environment
19. Which
is an example of a single dose order?
|
a. |
Diflucan (fluconazole) 150
mg PO at 10:00 today only |
|
b. |
Diflucan (fluconazole) 150
mg PO daily |
|
c. |
Tylenol (acetaminophen) 325
mg PO every 6 hours PRN |
|
d. |
Tylenol (acetaminophen) 650
mg PO stat |
ANS: A
A single
dose order is a type of medication order that is to be given
one time only.
DIF: Cognitive Level: Apply
REF: p. 30 | Table 3-3
OBJ:
7
TOP: Types of Medication Orders
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
20. The
nurse is administering a controlled substance that is ordered in a smaller dose
than what is available. What should the nurse do with the remaining amount of
medication?
|
a. |
Save the remaining
medication until the patient is scheduled to take the medication again. |
|
b. |
Flush the remaining
medication in the toilet in the patient’s bathroom. |
|
c. |
Ask another nurse to
witness the waste, sign the inventory report, and document the situation. |
|
d. |
Administer the dose that is
available and not the smaller dose ordered. |
ANS: C
If the ordered dose is smaller than the dose provided (so that
some medication must be discarded), or if the medication is accidentally
dropped, contaminated, spilled, or otherwise made unusable and unreturnable,
two nurses must sign the inventory report and describe the situation.
DIF: Cognitive Level:
Understand
REF: p.
28
OBJ: 4
TOP: Controlled
Substances
KEY: Nursing Process Step: Assessment
MSC: NCLEX: N/A
MULTIPLE RESPONSE
21. Which
should the nurse do to identify medication errors in a patient’s order? (Select all that apply.)
|
a. |
Clarify anything that is
unreadable. |
|
b. |
Check the order in a
medication Kardex. |
|
c. |
Clarify vague orders with
the prescribing physician. |
|
d. |
Ask the patient about the
medication. |
|
e. |
Identify the medication
with an old medication record. |
ANS: A, B, C
The nurse is responsible for checking that the medication order
is correct. This may mean that you need to check the order you have in a
medication Kardex and get clarification from the prescriber for any orders that
are unclear.
DIF: Cognitive Level:
Apply
REF: p.
25
OBJ: 4
TOP: Medication
Errors
KEY: Nursing Process Step: Assessment
MSC: NCLEX: Physiological Integrity
22. Which
levels of regulation must the nurse adhere to when administering
medications? (Select
all that apply.)
|
a. |
City |
|
b. |
County |
|
c. |
Federal |
|
d. |
State |
|
e. |
Institutional |
ANS: C, D, E
Nurses who give medications have three levels of rules to
follow: federal (describes and controls), state (regulates who dispenses), and
individual hospital or agency (has other guidelines or policies).
DIF: Cognitive Level:
Remember
REF: p.
21
OBJ: 4
TOP: Rules for Giving
Drugs
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
23. A
health care provider has written the following order: Mylanta 30 mL PO 30 minutes ac.
How should the nurse giving this medication interpret this order? (Select all that apply.)
|
a. |
Administer by mouth 30
minutes before meals. |
|
b. |
Administer by mouth 30
minutes after meals. |
|
c. |
Administer by mouth with no
regard to meals. |
|
d. |
Administer medication, eat
in 30 minutes. |
|
e. |
Take 30 minutes to eat,
then take medication. |
ANS: A, D
A common abbreviation used for the direction of medication and
meals is ac (ante
cibum), which means “before meals.” The abbreviation PO means “by mouth.”
DIF: Cognitive Level:
Apply
REF: Table 3-4 OBJ:
7
TOP: Medication
Orders
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
24. The
narcotic control system is used by nurses working in any hospital or agency.
Which of the following are special conditions that all nurses must
follow? (Select all
that apply.)
|
a. |
Narcotics are watched by
everyone on the unit. |
|
b. |
Medication is stored in a
special locked cabinet. |
|
c. |
Narcotics may be borrowed
from one patient to use for another patient. |
|
d. |
The nurse signs for the
medication. |
|
e. |
An inventory must be kept
on drugs. |
ANS: B, D, E
Narcotics are stored in special, limited-access, locked
cabinets. A nurse records all controlled-substance medication during the shift.
The inventory report form is completed before the drug is removed from the
cabinet.
DIF: Cognitive Level:
Apply
REF: p.
28
OBJ: 5
TOP: Narcotic Control
System
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
25. At
change of shift, two nurses (one from each shift) discover a discrepancy in the
narcotics inventory for morphine 5 mg/mL vials. The count is short by one vial.
Which of the following steps should be taken to reconcile the count? (Select all that apply.)
|
a. |
Only nurses on the
off-going shift that actually used the automated dispensing system or the
narcotics cabinet should be asked about medication they have given. |
|
b. |
Steps must be retraced to
identify whether someone forgot to record any medication removed. |
|
c. |
Check patient charts (MAR)
to see if medication was given that was not signed for on the inventory
report. |
|
d. |
Notify security for large
errors. |
|
e. |
Notify the nursing
supervisor (charge nurse) and the pharmacy department of any undocumented
(unreconciled) discrepancy. |
ANS: B, C, D, E
All nurses having access to the key must be asked about
medication they have given. Steps must be retraced to see if someone forgot to
record any medication. Patient charts might also be checked to see if
medication was given that was not signed for on the inventory report. If errors
in the report cannot be found, both the pharmacy and the nursing service office
must be notified. If the error is large, the hospital administrator and
security police are usually contacted.
DIF: Cognitive Level:
Apply
REF: p.
28
OBJ: 5
TOP: Controlled
Substances
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment
26. When
a nurse realizes that a medication error has occurred, the nurse should take
which of the following steps? (Select
all that apply.)
|
a. |
Immediately check the
patient and determine if the error poses a risk to the patient’s condition.
If so, notify the physician immediately. |
|
b. |
Try to find someone to
blame for the error. |
|
c. |
Notify the nursing
supervisor. |
|
d. |
Analyze how and why the
error occurred, and how it might be avoided in the future. |
|
e. |
Record in the patient’s
chart exactly what happened and fill out any other required
(incident/medication error) reports. |
ANS: A, C, D, E
Research must be done to determine whether the mistake was a
“system error,” a unique mistake, or a deliberate wrongdoing. The goal is to
avoid similar future occurrences.
DIF: Cognitive Level:
Understand
REF: p. 28 | p. 31 OBJ: 8
TOP: Medication
Errors
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
Chapter 4: Foundations and Principles of Pharmacology
Edmunds: Introduction to Clinical Pharmacology, 8th Edition c
MULTIPLE CHOICE
1. Which
is always true regarding the generic name for a drug?
|
a. |
It is capitalized when
written. |
|
b. |
It is the same in any
country. |
|
c. |
It is assigned by a
specific manufacturer. |
|
d. |
It is similar to the
chemical name. |
ANS: B
The generic name is the common drug name used. This name is the
same in all countries. The generic drug name is written in lower-case letters,
whereas the trade name or brand name of a drug is capitalized.
DIF: Cognitive Level:
Remember
REF: p.
34
OBJ: 2
TOP: Drug Names KEY: Nursing Process
Step:
N/A
MSC: NCLEX: N/A
2. What
should the nurse do when writing the trade and generic name of a drug?
|
a. |
Capitalize both trade and
generic names. |
|
b. |
Capitalize the trade name
but not the generic name. |
|
c. |
Capitalize only the generic
name. |
|
d. |
The trade name is not
capitalized. |
ANS: B
Generic names are not capitalized when written. The first letter
of the trade name is capitalized, and sometimes other letters as well.
DIF: Cognitive Level: Understand
REF: p.
34
OBJ: 2
TOP: Drug Names KEY: Nursing
Process Step: Implementation
MSC: NCLEX: N/A
3. Chemical
names are different from trade or brand names because chemical names describe
which of the following?
|
a. |
Atomic or molecular
structure |
|
b. |
Metabolic and chemical
structure |
|
c. |
Generic or chemical
structure |
|
d. |
Receptor and agonist
structure |
ANS: A
Chemical names are often the most difficult to remember because
they include the chemicals that make up the drug. These names are usually long
and hyphenated and describe the atomic or molecular structure.
DIF: Cognitive Level:
Understand
REF: p.
34
OBJ: 2
TOP: Drug Names KEY: Nursing
Process Step: N/A
MSC: NCLEX: N/A
4. A
patient is admitted to the hospital for complaints of drowsiness and nausea
after taking an over-the-counter medication for seasonal allergies. What
potential problem is this?
|
a. |
Adverse effect |
|
b. |
Desired action |
|
c. |
Side effect |
|
d. |
Paradoxical response |
ANS: A
Adverse reactions, or adverse effects, usually imply relatively
severe symptoms or problems that develop because of the drug.
DIF: Cognitive Level:
Apply
REF: p. 37
OBJ: 3
TOP: Drug
Actions
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
5. Which
explanation by the nurse explains to a patient that water should be taken with
a tablet?
|
a. |
“Juice or milk can keep it
from dissolving.” |
|
b. |
“Water is important for
proper metabolism.” |
|
c. |
“Water keeps the medicine
potent.” |
|
d. |
“Water helps to dissolve
the medication.” |
ANS: D
When the patient takes water with a tablet, it not only helps in
swallowing but also helps dissolve the medication and increase its solubility.
DIF: Cognitive Level:
Understand
REF: p.
35
OBJ: 4
TOP: The Process of
Absorption
KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
6. Which
medication is absorbed most rapidly?
|
a. |
Subcutaneous insulin |
|
b. |
Intravenous antibiotic |
|
c. |
Rectal suppository |
|
d. |
Sublingual nitroglycerin |
ANS: B
Medications injected intravenously into the bloodstream have the
fastest action.
DIF: Cognitive Level:
Remember
REF: p.
35
OBJ: 4
TOP: The Process of
Absorption
KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
7. A
nurse is administering a patient’s medication by mouth. The nurse knows that
for this medication to be utilized by the body, diffusion, filtration, and
osmosis must take place. Which mechanism is the first to be involved in that
process?
|
a. |
Excretion |
|
b. |
Metabolism |
|
c. |
Distribution |
|
d. |
Absorption |
ANS: D
Absorption involves the way a drug enters the body and passes
into the body and tissues. Absorption takes place through the processes of
diffusion, filtration, and osmosis.
DIF: Cognitive Level:
Understand
REF: p.
35
OBJ: 4
TOP: The Process of
Absorption
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity
8. What
is the process by which molecules move from a region of higher concentration to
one of lower concentration?
|
a. |
Diffusion |
|
b. |
Osmosis |
|
c. |
Filtration |
|
d. |
Solubility |
ANS: A
In diffusion, molecules move from a region of higher
concentration to one of lower concentration.
DIF: Cognitive Level:
Remember
REF: p. 35 | Box 4-2
OBJ:
4
TOP: The Process of
Absorption
KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
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