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Pharmacology Connections to Nursing 1st Edition Adams Koch Test Bank

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Pharmacology Connections to Nursing 1st Edition Adams Koch Test Bank

ISBN-13: 978-0131525993

ISBN-10: 0131525999

 

Description

Pharmacology Connections to Nursing 1st Edition Adams Koch Test Bank

ISBN-13: 978-0131525993

ISBN-10: 0131525999

 

 

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Adams: Pharmacology: Connections to Nursing Practice, 1e

Chapter 13

Psychosocial, Gender, and Cultural Influences on Pharmacotherapy

 

Learning Outcomes:

  1. Describe fundamental concepts underlying a holistic approach to patient care, and their importance to pharmacotherapy.
  2. Describe the components of the human integration pyramid model.
  3. Identify psychosocial and spiritual factors that can affect pharmacotherapeutics.
  4. Explain how ethnicity can affect pharmacotherapeutic outcomes.
  5. Identify examples of how cultural values and beliefs can influence pharmacotherapeutic outcomes.
  6. Convey how genetic polymorphisms can influence pharmacotherapy.
  7. Relate the implications of gender to the actions of certain drugs.

 

Learning Outcome 1 Describe fundamental concepts underlying a holistic approach to patient care, and their importance to pharmacotherapy.

 

 

  1. The nurse is doing a holistic assessment on a client prior to the initiation of antihypertensive

medication. What factors would be included in a holistic assessment? (Select all that apply).

  1. Blood pressure
  2. Mood
  3. Level of education
  4. The cause of the hypertension
  5. Belief in a higher power

Answers: 1, 2, 3, 5

Rationale:

  1. Holistic health care incorporates the whole client to include the biological dimension.
  2. Holistic health care incorporates the whole client to include the psychological.
  3. Holistic health care incorporates the whole client to include the sociocultural dimension.
  4. Focuses on a specific disease, and its cause and treatment; this is a medical model, not a holistic model.
  5. Holistic health care incorporates the whole client to include the spiritual dimension.

Cognitive Level: Analysis

Client Need: Physiological Integrity

Nursing Process: Assessment

Learning Outcome: 13-1

 

  1. The nurse is conducting a holistic assessment of a client with alcoholism. What are the

priority questions that the nurse should include in the assessment? (Select all that apply)

  1. “Have you ever been in alcohol rehabilitation before?”
  2. “Are any of your blood relatives been addicted to alcohol?”
  3. “Have you ever attended Alcoholic Anonymous meetings?”
  4. “Did you see your parents drink alcohol when you were growing up?
  5. “How is drinking alcohol viewed by your culture?”

Answer: 2, 4, 5

Rationale:

  1. Participation in a rehabilitation program refers to treatment, and does not have relevance to a holistic assessment.
  2. Biological questions are valid questions to ask during a holistic assessment.
  3. Participation in Alcoholic Anonymous refers to treatment, and does not have relevance to a holistic assessment.
  4. Environmental questions are valid questions to ask during a holistic assessment.
  5. Cultural questions are valid questions to ask during a holistic assessment.

Cognitive Level: Analysis

Client Need: Physiological Integrity

Nursing Process: Assessment

Learning Outcome: 13-1

 

Learning Outcome 2 Describe the components of the human integration pyramid model.

 

 

  1. The nurse is assessing a client using the human integration model as a conceptual

framework. How does this model assist the nurse in dealing holistically with the client’s

problems?

  1. Levels of the pyramid are independent and unconnected.
  2. Ensures that pharmacotherapy is only treating the symptoms.
  3. All levels of the pyramid are interconnected and interdependent.
  4. It’s a useful approach in addressing the medical needs of the client.

Answer: 3

Rationale:

  1. All levels of the pyramid are interconnected and interdependent.
  2. Consideration of all the levels helps to ensure that the pharmacotherapy is not only treating the symptoms, but also addressing the related issues of the entire client.
  3. As nurses address pharmacological needs, each level of the pyramid is considered in relationship to the therapy.
  4. The model provides a useful approach to addressing the nursing and pharmacological needs of the client.

Cognitive Level: Analysis

Client Need: Physiological Integrity

Nursing Process: Implementation

Learning Outcome: 13-2

 

Learning Outcome 3 Identify psychosocial and spiritual factors that can affect pharmacotherapeutics.

 

  1. The client is diagnosed with cancer. The health care provider has recommended chemotherapy, which would likely save the client’s life. The client tells the nurse, “This is a punishment from God for the sins I have committed; some of the women at my Church say so.” What is the best plan of action for the nurse based obtaining the consent of the client?
  1. Plan to contact the client’s minister to discuss the client’s perspective about cancer.
  2. Plan to meet with family members to discuss the client’s perspective about cancer.
  3. Plan to bring the case before the hospital’s board of ethics.
  4. Plan to involve a hospital minister to discuss the client’s perspective about cancer.

Answer: 1

Rationale:

  1. When clients have strong religious beliefs, these can affect the outcome of the illness. The nurse should involve the client’s religious leader when possible.
  2. Meeting with the client’s family might help; however, they might have the same perspective as the client.
  3. Bringing the case before the hospital board of ethics is premature at this point.
  4. Involving the hospital minister might be an option, but it is best to work through the client’s minister initially.

Cognitive Level: Analysis

Client Need: Physiological Integrity

Nursing Process: Implementation

Learning Outcome: 13-3

 

  1. The client is a Native American admitted to the hospital for chemotherapy. At any given time, five family members are in the client’s private room. The nurse tells the client that according to hospital policy, only two visitors at a time are allowed. What is the nurse manager’s analysis of the situation?
  2. The nurse was following protocol by informing the client about hospital policy.
  3. The nurse should have assessed the client’s preference about how many family members he wanted to be present.
  4. The nurse should have allowed the client to have as many family members as he wanted to be present.
  5.   The nurse should have called the health care provider and obtained an order for additional

family members to be present.

Answer: 2

Rationale:

  1. The nurse should have assessed the client’s preference about how many visitors he wanted in his room before so strictly interpreting the hospital rules.
  1. Many hospital rules, such as how many visitors are allowed, are flexible, and do not have to be strictly interpreted; this client is in a private room.
  2. The nurse must be realistic with regard to the number of family members the client wants present: Five family members is acceptable; twenty would be too many.
  3. This situation can be resolved by the nurse; there is need for a health care provider’s order at this point.

Cognitive Level: Analysis

Client Need: Physiological Integrity

Nursing Process: Evaluation

Learning Outcome: 13-3

 

 

Learning Outcome 4 Explain how ethnicity can affect pharmacotherapeutic outcomes.

 

  1. An African-American client had an myocardial infarction, and is receiving atorvastatin

(Lipitor). The nurse caring for the client is Caucasian. The nurse assesses the client’s diet to be very high in fat. What is the best teaching plan by the nurse to improve the client’s diet and reduce the risk for additional medications?

  1. Plan to ask an African-American nurse to speak to her about low-fat diets.
  2. Ask the health care provider for a consult by dietary services so a dietician can teach the

client about low-fat diets.

  1. Discuss her diet with whomever prepares meals for the family.
  2. Give the client information specific to African-Americans about low-fat diets.

Answer: 3

Rationale:

  1. This is racist, and implies that a Caucasian nurse cannot understand the dietary needs of an African-American client.
  1. At this point, a consult by dietary services is premature.
  2. Every culture has culture-specific diets; the nurse must include the person in the family

who does the meal preparation if a different diet is to be successful.

  1. Providing information is a good idea, but the nurse also must teach the client.

Cognitive Level: Analysis

Client Need: Physiological Integrity

Nursing Process: Implementation

Learning Outcome: 13-4

 

  1. The nurse is caring for an Asianclient with terminal cancer. What is an important

factor for the nurse to consider in giving adequate pain control to the client?

  1. All ethnic groups respond to medications in the same manner.
  2. Asians respond differently only to antidepressants.
  3. Drug metabolism is affected differently only in African-Americans.
  4. Opioids are metabolized differently in individuals of Asian and Native American descent.

Answer: 4

Rationale:

  1. Research demonstrates a biological basis for variations or differences in metabolism response to agents among various ethnic groups.
  2. Asians respond differently to antidepressants, antidysrhythmics, and opioids.
  3. Drug metabolism is metabolized differently by various ethnic groups.
  4. Opioids are also metabolized differently by African Americans. The nurse must understand how the drug is metabolized to be able to ensure that the correct dose is being given.

Cognitive Level: Analysis

Client Need: Physiological Integrity

Nursing Process: Evaluation

Learning Outcome: 13-4

 

Learning Outcome 5 Identify examples of how cultural values and beliefs can influence pharmacotherapeutic outcomes.

 

  1. An adolescent Hispanic male has been diagnosed with Attention Deficit Hyperactivity

Disorder (ADHD), and is taking methylphenidate (Ritalin). Even though the drug helps

him with focusing and grades, the adolescent will not go to the school nurse at noon for his medication. Which statement best describes the result of the nurse’s evaluation?

  1. The adolescent really does not need an additional dose of methylphenidate (Ritalin) at school.
  2. The adolescent has developed alternative coping mechanisms to increase his focus during classes.
  3. The adolescent is fearful that this drug might be a “gateway drug” and he will abuse other substances.
  4. The adolescent is embarrassed about having to take medicine at school; it is a social stigma.

Answer: 4

Rationale:

  1. Methylphenidate (Ritalin) is a short-acting drug, and doses must be administered about four hours apart, so the client must receive a dose during school hours.
  2. ADHD is a brain-based disorder, and the primary treatment is medication; alternative coping mechanisms will not usually help to increase focus during classes.
  3. Appropriate treatment of ADHD will result in less addiction, not more addiction, to mood-altering substances.
  4. Some clients believe that having to take drugs in school will cause them to be viewed as weak, unhealthy, or dependent. Clients can also perceive this as a social stigma.

Cognitive Level: Evaluation

Client Need: Physiological Integrity

Nursing Process: Assessment

Learning Outcome: 13-5

 

  1. The client is from an Arab culture and is in labor and delivery. Her husband insists he must

stay with her, and will not allow her to receive any analgesia during the experience. What is

the best action by the nurse?

  1. Inform the husband that it is his wife’s choice whether to receive analgesia.
  2. Allow this request, and be available in the event the request changes.
  3. Allow the request, but inform the husband that the primary health care provider will make the final decision regarding analgesia.
  4. Inform the husband that he must sign a release of responsibility to avoid future litigation against the hospital.

Answer: 2

Rationale:

  1. In some cultures the husband, not the wife, makes the choices for health care.
  2. Nurses must allow and support cultural differences. The husband’s decisions must be respected as long as the client’s safety is not involved, and it is not involved in this situation.
  3. In some cultures, the husband, not the primary health care provider, makes the health care decisions.
  4. When cultural differences are allowed and supported, clients are not as likely to become involved in litigation.

Cognitive Level: Analysis

Client Need: Physiological Integrity

Nursing Process: Implementation

Learning Outcome: 13-5

 

Learning Outcome 6 Convey how genetic polymorphisms can influence pharmacotherapy.

 

  1. The nurse is providing group education about warfarin (Coumadin) to a group of Asian- and African-American clients who have experienced strokes. The nurse determines that learning has occurred when the clients make which statement?
  2. “We might need less medication than other ethnic groups.”
  3. “We might need to have more frequent blood tests.”
  4. “We might need more medication than other ethnic groups.”
  5. “We might need to have less frequent blood tests.”

Answer: 1

Rationale:      

  1.  Asian- and African-Americans have reduced metabolism rates of warfarin (Coumadin), so they will often require lower doses to prevent toxicity.
  2.  There is no need for Asian- and African-American clients to have more frequent blood tests if their dosage is regulated based on their reduced metabolism of the drug.
  3. They would need less medication, not more, related to their reduced metabolism rate of the drug.
  4. Since they have a reduced metabolism rate of warfarin, reduced blood tests would not seem appropriate.

Cognitive Level: Analysis

Client Need: Physiological Integrity

Nursing Process: Implementation

Learning Outcome: 13-6

 

  1. The primary health care provider has prescribed isoniazid (INH) for a client of Japanese descent diagnosed with tuberculosis. What important factor must the nurse take into consideration in regard to the       therapeutic effectiveness of this drug?
  1. Clients of Japanese descent are known as slow acetylators.
  2. Clients of Japanese descent are usually allergic to isoniazid.
  3. Clients of Japanese descent are known as rapid acetylators.
  4. Clients of Japanese descent do not need medication to treat their tuberculosis.

Answers: 3

Rationale:      

  1. Japanese descent clients are rapid acetylators, and inactivate the drug too quickly for it to produce a therapeutic effect.
  2. There is no documented proof that clients of Japanese descent are any more or less allergic to isoniazid than is any other ethnic group.
  3. They are rapid acetylators, and will inactivate the drug so quickly that it will not produce a therapeutic effect.
  4. All ethnic groups require medication to treat tuberculosis.

Cognitive Level: Analysis

Client Need: Physiological Integrity

Nursing Process: Evaluation

Learning Outcome: 13-6

 

 

Learning Outcome 7 Relate the implications of gender to the action of certain drugs.

 

  1. A male client comes into the Emergency Department with chest pain; his blood pressure is 210/100 mm/Hg. The client’s wife says to the nurse, “He has not been taking his blood pressure medication, and we can afford it.” What should the best plan of action for the nurse include?
  1. Plan to teach the client the importance of taking his medication.
  2. Plan to design a teaching plan about medication that includes the client’s wife.
  3. Plan to assess the client for any cultural concerns about the medication.
  4. Plan to assess the client for sexual side effects such as erection difficulty.

Answer: 4

Rationale:      

  1. It is premature to teach      the importance of medication to the client without first assessing the reason for noncompliance.
  2. It is premature to talk to the client’s wife.
  3. Assessment of cultural beliefs is important, but with medications, assessment of side effects is initially        more important.
  4. A common side effect of antihypertensive medication in males is sexual difficulty, such as erection problems.

Cognitive Level: Analysis

Client Need: Physiological Integrity

Nursing Process: Implementation

Learning Outcome: 13-7

 

  1. The nurse is teaching a class on how to prevent heart attacks to clients. It is a mixed-gender class. What important factor does the nurse need to include in the teaching plan related to gender?
  1. Heart disease affects men and women equally.
  2. All medications used to prevent heart attacks affect men and women the same.
  3. Certain medications, such as aspirin, are more effective in preventing heart attacks in men than in women.
  4.  Certain medications, such as aspirin, are more effective in preventing heart attacks in women than in men.

Answer: 3

Rationale:      

  1. Heart attacks are more common in women later in life. Men are affected early in the lifespan.
  2. Some medications affect gender differently. It is based on the different expression of the genes.
  3. Aspirin is more effective in preventing heart attacks in men than in women.
  4. Aspirin is more effective in preventing heart attacks in men than in women.

Cognitive Level: Analysis

Client Need: Physiological Integrity

Nursing Process: Implementation

Learning Outcome: 13-7