Adams4e Tif Ch42

Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/EChapter 42Question 1Type: MCSA

The client has been consuming very high amounts of vitamin A. He asks the nurse why this is a problem since it is just a vitamin. What is the best response by the nurse?

1. "Water-soluble vitamins like vitamin A are readily excreted in your urine."

2. "It really isn't a problem; your body will just get rid of the excess vitamins."

3. "It's okay to take what you want; just cut back if you experience side effects."

4. "Fat-soluble vitamins like vitamin A are stored in your body, and too much can be toxic."

Correct Answer: 4

Rationale 1: Vitamin A is a fat-soluble vitamin and is not readily excreted in the urine; only the water-soluble vitamins like B and C will be excreted in the urine.

Rationale 2: Fat-soluble vitamins can be stored in large quantities in the liver and adipose tissue. This storage may lead to dangerously high levels if taken in excessive amounts.

Rationale 3: By the time the client experiences side effects, toxicity has occurred, so this is bad advice.

Rationale 4: Fat-soluble vitamins can be stored in large quantities in the liver and adipose tissue. This storage may lead to dangerously high levels if taken in excessive amounts.

Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 42-2

Question 2Type: MCMA

The physician orders multivitamins for the client. The client asks the nurse why she needs vitamins. What will the best teaching plan by the nurse include?

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

Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

Standard Text: Select all that apply.

1. Small amounts of vitamins are needed for health.

2. Vitamins will heal many illnesses.

3. Vitamins are inorganic compounds that are not stored in the body.

4. Your body cannot synthesize most vitamins.

5. Vitamins are needed for growth and maintenance of normal metabolic processes.

Correct Answer: 1,4,5

Rationale 1: Vitamins are organic compounds. They are needed for health.

Rationale 2: Vitamins are great nutritional support, but there are very few illnesses that vitamins will heal.

Rationale 3: Vitamins are organic compounds, but many are stored in the body.

Rationale 4: Only vitamin D can be synthesized.

Rationale 5: Vitamins are needed for growth and maintenance of normal metabolic processes.

Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: 42-1

Question 3Type: MCSA

The client is receiving enteral nutrition. He reads on the bag hanging at his bedside that the liquid is a polymeric formulation. He asks the nurse what this means. What is the best response by the nurse?

1. "It means that your formulation contains varying amounts of free amino acids and peptide combinations."

2. "It means that your formulation contains various mixtures of proteins, carbohydrates, and lipids."

3. "It means that your formulation contains a specific nutrient combination for your particular condition."

4. "It means that your formulation contains a single nutrient, protein, lipid, or carbohydrate."

Correct Answer: 2Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

Rationale 1: Oligomeric formulations are agents containing varying amounts of free amino acids and peptide combinations.

Rationale 2: Polymeric formulations are the most common enteral preparations. These products contain various mixtures of proteins, carbohydrates, and lipids.

Rationale 3: Specialized formulations are products that contain a specific nutrient combination for a particular condition.

Rationale 4: Modular formulations contain a single nutrient, protein, lipid, or carbohydrate.

Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 42-7


The nurse assesses which client as being at greatest risk for developing vitamin deficiencies?

1. The young male client who takes phenytoin (Dilantin) for new-onset epilepsy

2. The young female client who uses oral contraceptives for birth control

3. The young male client who eats a well-balanced diet and does not take vitamins

4. The young pregnant female client who is taking prenatal vitamins

Correct Answer: 2

Rationale 1: Certain anticonvulsants can be associated with B complex deficiencies, but the client is just starting therapy so he is not at great risk.

Rationale 2: The use of oral contraceptives is associated with deficiencies of B complex vitamins.

Rationale 3: Most nutritional demands can be met with a well-balanced diet.

Rationale 4: The prenatal vitamins will meet all the vitamin requirements of the pregnant female.

Global Rationale:

Cognitive Level: AnalyzingClient Need: Physiological IntegrityAdams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

Client Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 42-4


The nurse teaches new mothers about the reason their infants receive vitamin K. The nurse evaluates instruction as being effective when the mothers make which statement?

1. "Our babies do not need an injection of vitamin K unless bleeding is observed."

2. "Our babies will be able to get enough vitamin K through breast milk."

3. "Our babies do not have enough intestinal bacteria to synthesize vitamin K."

4. "Our babies could receive vitamin K through a liquid or an injection."

Correct Answer: 3

Rationale 1: Vitamin K injection must be used before bleeding is observed in the infant.

Rationale 2: Vitamin K is not present in high enough amounts in breast milk to protect the infant from bleeding.

Rationale 3: The infant's gut is sterile, so there is inadequate bacteria to synthesize vitamin K, which is essential to promote blood clotting.

Rationale 4: The stimulus for vitamin K rests with an injection, not a liquid form, to promote blood clotting and stimulate intestinal synthesis of the vitamin.

Global Rationale:

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: EvaluationLearning Outcome: 42-4


A pregnant client asks the nurse if she can take vitamin supplements in addition to her prenatal vitamins. What is the best response by the nurse?

1. "As long as you meet the recommended daily allowance (RDA) requirements, there will be no problem."


2. "The prenatal vitamins supply all the vitamins you need during your pregnancy."

3. "This is dangerous; we need to do an ultrasound of your baby."

4. "Bring in your vitamins on the next visit so we can include them in your chart."

Correct Answer: 2

Rationale 1: Additional vitamins could lead to toxicity; the client should not take additional vitamin supplements as the RDA requirements are met by the prenatal vitamins.

Rationale 2: Prenatal vitamins supply all the vitamins a client needs during a pregnancy; there is no need for additional supplementation.

Rationale 3: An ultrasound of the baby is premature and this comment would unnecessarily alarm the client.

Rationale 4: Additional vitamins could lead to toxicity and be dangerous for the fetus; the nurse should not tell the client the vitamins will be included in the chart.

Global Rationale:

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 42-3


The client receives topical vitamin A for the treatment of psoriasis. Which laboratory test will the nurse review when assessing for an adverse effect?

1. Serum calcium level

2. Hemoglobin level

3. Thyroid profile

4. Serum potassium level

Correct Answer: 1

Rationale 1: Vitamin A may increase serum calcium.

Rationale 2: There is no reason to assess the hemoglobin level.


Rationale 3: There is no reason to assess the thyroid profile.

Rationale 4: There is no reason to assess the serum potassium level.

Global Rationale:

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 42-9


Which clinical conditions would the nurse most likely associate with a client who has a documented history of alcoholism?



1. Pernicious anemia

2. Thiamine deficiency

3. Scurvy

4. Vitamin A deficiency

5. Pellagra

Correct Answer: 2,3,4,5

Rationale 1: Pernicious anemia is associated with an inability to produce vitamin B12, not alcoholism.

Rationale 2: Thiamine deficiency is commonly seen in alcoholic clients.

Rationale 3: Alcoholics are among those at highest risk for vitamin C deficiency or scurvy.

Rationale 4: Vitamin A deficiency is caused by prolonged dietary deprivation that may occur in alcoholism.

Rationale 5: Pellagra is a niacin deficiency that is commonly seen in alcoholic clients.

Global Rationale:


Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Physiological AdaptationNursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 42-4


The client has preeclampsia and might require magnesium sulfate therapy. Which of the following is a critical assessment parameter by the nurse?

1. Fetal heart sounds

2. Deep tendon reflexes

3. Peripheral edema

4. Breath sounds

Correct Answer: 2

Rationale 1: Fetal heart sounds, although always important, are not the critical assessment in this situation.

Rationale 2: A decrease in deep tendon reflexes indicates that the client has a low magnesium level. This puts the client at risk for seizures related to preeclampsia.

Rationale 3: Peripheral edema is not a critical assessment in this situation.

Rationale 4: Breath sounds, although always important, are not the critical assessment in this situation.

Global Rationale:

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 42-10


The nurse is planning care for a client who receives total parenteral nutrition. What will the best plan by the nurse include?

1. Check the feeding tube for residual prior to initiating feedings.Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

2. Remove the solution from the refrigerator 30 minutes prior to hanging.

3. Withhold oral medications while the total parenteral nutrition (TPN) is hanging.

4. Maintain a dedicated percutaneous endoscopic gastrostomy (PEG) tube for the solution.

Correct Answer: 2

Rationale 1: Checking the tube for residual is done with enteral feedings, not parenteral feedings.

Rationale 2: A cold infusion could cause irritation to the intravenous (IV) site.

Rationale 3: The client can continue to receive oral medications while total parenteral nutrition (TPN) is infusing.

Rationale 4: Parenteral infusions are done through an intravenous (IV) line, not a percutaneous endoscopic gastrostomy (PEG) tube.

Global Rationale:

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: 42-8


The client is a vegetarian. What information would the nurse give the client as it relates to the avoidance of vitamin deficiencies?

1. A vegetarian diet is adequate to meet all of your needs, so there should be no vitamin deficiencies.

2. Look at the types of foods eaten on the vegetarian diet, and evaluate for possible vitamin B12 sources.

3. Increasing fluids and fiber with the vegetarian diet will help prevent vitamin deficiencies.

4. You are at risk for vitamin C deficiencies by following a vegetarian diet.

Correct Answer: 2

Rationale 1: A vegetarian diet may not be adequate; it depends on the type of vegetarian diet the client is following.

Rationale 2: Vitamin B12 is found only in animal sources, but this does include eggs and dairy products. Some vegetarian diets allow eggs and/or dairy products.


Rationale 3: Increasing fluids and fiber will not help correct any vitamin deficiencies.

Rationale 4: A vegetarian diet is almost never deficient in vitamin C as this vitamin is plentiful in fruits and vegetables.

Global Rationale:

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Physiological AdaptationNursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 42-10


The nurse teaches elderly citizens at a senior citizen center about the effectiveness of vitamin C in preventing the common cold. The nurse evaluates that learning has occurred when the elderly citizens make which statement?

1. "Vitamin C, in the form of orange juice, is the most effective aid in preventing the common cold."

2. "There is no proof that vitamin C prevents the common cold."

3. "Vitamin C is only effective in preventing the common cold if 2 grams/day are taken.”

4. "Vitamin C must be taken prior to the onset of the cold to be most effective."

Correct Answer: 2

Rationale 1: There is no clinical evidence to support that orange juice is the most effective form of vitamin C in preventing the common cold.

Rationale 2: The ability of vitamin C to prevent the common cold has not been definitely proved.

Rationale 3: The efficacy of vitamin C against the common cold has not been proven.

Rationale 4: There is no evidence to support that vitamin C must be taken before a cold in order to be effective.

Global Rationale:

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: EvaluationLearning Outcome: 42-2



The nurse teaches young females in college about the importance of vitamins for anyone planning on becoming pregnant. Which vitamin does the nurse include as being most essential in the prevention of neural tube defects in a fetus?

1. Thiamine

2. Niacin

3. Riboflavin

4. Folic acid

Correct Answer: 4

Rationale 1: Folic acid, not thiamine, is the vitamin that is essential for the prevention of neural tube defects in a fetus.

Rationale 2: Folic acid, not niacin, is the vitamin that is essential for the prevention of neural tube defects in a fetus.

Rationale 3: Folic acid, not riboflavin, is the vitamin that is essential for the prevention of neural tube defects in a fetus.

Rationale 4: Folic acid is the vitamin that is essential for the prevention of neural tube defects in a fetus.

Global Rationale:

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 42-2


The client is receiving total parenteral nutrition. What does the best plan by the nurse include to prevent complications from total parenteral nutrition (TPN)?

1. Assess the client's potassium levels.

2. Assess the client's blood glucose levels.


3. Assess the client's mental status.

4. Assess the client's blood pressure.

Correct Answer: 2

Rationale 1: The client's potassium levels should not be affected by total parenteral nutrition (TPN).

Rationale 2: Hyperglycemia may occur, as total parenteral nutrition (TPN) solutions contain concentrated amounts of glucose.

Rationale 3: The client's mental status should not be affected by total parenteral nutrition (TPN).

Rationale 4: Blood pressure is not an essential assessment for a client receiving total parenteral nutrition (TPN).

Global Rationale:

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: PlanningLearning Outcome: 42-10


Vitamins are organic substances needed in

1. large amounts to decrease cell size.

2. large amounts to promote health.

3. small amounts to promote growth.

4. small amounts to increase cell size.

Correct Answer: 3

Rationale 1: Cells do not supply vitamins; they are needed in the diet.

Rationale 2: Vitamins are not needed in large amounts.

Rationale 3: Vitamins are needed in small amounts to promote growth and maintain health.

Rationale 4: Cells do not supply vitamins; they are needed in the diet.

Global Rationale: Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

Cognitive Level: RememberingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 42-1


Vitamin C is necessary for the

1. maintenance of vision.

2. regulation of digestion.

3. development of bones and teeth.

4. manufacture of platelets.

Correct Answer: 3

Rationale 1: Vision is maintained by vitamin A.

Rationale 2: Vitamin B helps with metabolic processes, such as digestion.

Rationale 3: Vitamin C is necessary for development of bones, teeth, and blood vessels.

Rationale 4: Vitamin C is not essential in the manufacturing of platelets.

Global Rationale:

Cognitive Level: RememberingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Learning Outcome: 42-2


An important function of vitamin A is to

1. promote visual pigment of the eye.

2. act as an antioxidant.


3. help with the clotting of blood.

4. help with bile excretion.

Correct Answer: 1

Rationale 1: Vitamin A is needed for precursor retinol for normal vision.

Rationale 2: Vitamin C and E are antioxidants.

Rationale 3: Vitamin K is important in the clotting of blood.

Rationale 4: Vitamin B can help with metabolic processes.

Global Rationale:

Cognitive Level: RememberingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Learning Outcome: 42-2


Which of the following vitamins can be toxic if consumed in large amounts?

1. Niacin

2. Vitamin C

3. Vitamin A

4. Folic acid

Correct Answer: 3

Rationale 1: Niacin is vitamin B, and therefore water-soluble.

Rationale 2: Vitamin C is a water-soluble vitamin, and cannot be toxic.

Rationale 3: Vitamin A is lipid-soluble, and can be toxic in large amounts.

Rationale 4: Folic acid is a B vitamin, and is water-soluble.

Global Rationale:


Cognitive Level: RememberingClient Need: Physiological IntegrityClient Need Sub: Physiological AdaptationNursing/Integrated Concepts: Learning Outcome: 42-2


Deficiencies in cyanocobalamin (B12) can result in

1. pellagra.

2. pernicious anemia.

3. rickets.

4. scurvy.

Correct Answer: 2

Rationale 1: Pellagra is a deficiency of niacin.

Rationale 2: Cyanocobalamin (B12) deficiency can result in pernicious or megaloblastic anemia, and can require pharmacotherapy.

Rationale 3: Rickets is vitamin D deficiency.

Rationale 4: Scurvy is a deficiency of vitamin C.

Global Rationale:



The nurse is aware that efficient absorption of calcium is assisted by

1. intrinsic factor.

2. coenzymes.


3. phosphorus.

4. vitamin D.

Correct Answer: 4

Rationale 1: Efficient absorption of calcium is assisted by vitamin D.




Global Rationale:



A woman calls the emergency department and says, “My 2-year-old just swallowed about 20 of my magnesium tablets.” What direction should the nurse provide?



1. “Call 911 to bring your child to the emergency room immediately.”

2. “Watch your child for decreased breathing.”

3. “Give your child a glass of milk.”

4. “Your child may be sleepy, but will not have any permanent damage.”

5. “Give your child a laxative tonight and come to the emergency room in the morning.”

Correct Answer: 1,2

Rationale 1: This is an emergency situation and the child will require treatment.


Rationale 2: While waiting for the ambulance, the mother should observe the client for respiratory suppression.

Rationale 3: Drinking milk will not provide an antidote for magnesium overdose.

Rationale 4: This overdose is an emergency situation.

Rationale 5: The child needs immediate assessment and treatment.

Global Rationale:

Cognitive Level: AnalyzingClient Need: Physiological IntegrityClient Need Sub: Physiological AdaptationNursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 42.6


A nurse is concerned that a client is not eating a sufficient amount. Which assessment findings would support this concern?



1. The client complains of weakness.

2. The client’s muscles appear wasted.

3. The client doesn’t remember what day it is.

4. The client’s subcutaneous fat layer is thinner.

5. The client’s skin is oily.


Rationale 1: Generalized weakness is a common assessment in the client with insufficient intake.

Rationale 2: Muscle wasting is a common finding associated with insufficient intake of food.

Rationale 3: Confusion is an assessment finding associated with many disease processes and is not particular to insufficient intake.

Rationale 4: Loss of subcutaneous fat supports the diagnosis of insufficient intake.


Rationale 5: Insufficient intake would generally result in dry, flaky skin.

Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Physiological AdaptationNursing/Integrated Concepts: Nursing Process: AssessmentLearning Outcome: 42.10


A client is to receive enteral nutrition. Which information should the nurse provide to the client and family?



1. “Nutrition can be given either intermittently or continuously.”

2. “Your nutrition will be administered through your veins.”

3. “You will still be able to eat if you would like to do so.”

4. “Most enteral feeding consists of thinned pureed food.”

5. “Enteral feedings are milk based.”

Correct Answer: 1,3

Rationale 1: Enteral products can be given intermittently by bolus or by continuous drip.

Rationale 2: Parenteral nutrition is administered through the venous system. Enteral nutrition is delivered into the gastrointestinal tract.

Rationale 3: The client can continue to eat while most nutrition is being provided enterally.

Rationale 4: Most enteral feeding is formula based.

Rationale 5: Formulas consist of various combinations of proteins, carbohydrates, and lipids and are not milk based.

Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityAdams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/ECopyright 2014 by Pearson Education, Inc.

Client Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 42.8


A client is prescribed TPN. Which education should the nurse provide?



1. “You will not be able to return home until the TPN is discontinued.”

2. “Once you go home, you will come in twice a week for TPN.”

3. “Since this is going to be a long-term treatment, your TPN will be given through a central line.”

4. “Your TPN will be infused via an infusion pump.”

5. “All of your nutrition can be supplied by TPN.”


Rationale 1: TPN can be managed at home.

Rationale 2: TPN is administered continuously.

Rationale 3: Long-term therapy is provided through a central line.

Rationale 4: TPN must be monitored closely, so an infusion pump is necessary.

Rationale 5: TPN supplies all a client’s nutrition.

Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Pharmacological and Parenteral TherapiesNursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 42.8



A nurse is providing administration instruction to the wife of a client going home on intermittent enteral nutrition. Which information should the nurse include?



1. “Clean the equipment between each feeding administration.”

2. “Once mixed, enteral feeding should hang no more than 8 hours.”

3. “Refrigerate any feeding that is not needed for a feeding.”

4. “You may use plain tap water for scheduled tubing flushes.”

5. “Check placement of the feeding tube before starting the feeding.”

Correct Answer: 1,3,4,5

Rationale 1: The equipment used to provide enteral feedings should be kept clean.

Rationale 2: Enteral feedings should hang no more than 4 hours.

Rationale 3: Unused feeding should be refrigerated to prevent spoilage.

Rationale 4: Plain water is acceptable for tubing flushes.

Rationale 5: Confirmation of tube placement must be done before each feeding.

Global Rationale:

Cognitive Level: ApplyingClient Need: Physiological IntegrityClient Need Sub: Reduction of Risk PotentialNursing/Integrated Concepts: Nursing Process: ImplementationLearning Outcome: 42.8


Adams4e Tif Ch42

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