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A patient is diagnosed with cancer. The physician has recommended chemotherapy, which would likely save the patient's life. The patient tells the nurse, "This is punishment from God for sins I have committed; some women at my church say so." What will the best plan of the nurse include?
1. With the patient's permission, plan to involve a hospital minister to discuss the patient's perspective about cancer.
2. With the patient's permission, plan to bring the case before the hospital's board of ethics.
3. With the patient's permission, plan to contact the patient's minister to discuss the patient's perspective about cancer.
4. With the patient's permission, plan to meet with family members to discuss the patient's perspective about cancer.
Correct: 3
Rationale 1: Involving a hospital minister may be an option, but it is best to work through the patient's minister initially.
Rationale 2: Bringing the case before the hospital's board of ethics is premature at this point.
Rationale 3: When patients have strong religious beliefs, these can affect the outcome of the illness. The nurse should involve the patient's religious leader when possible.
Rationale 4: Meeting with family might help; however, they may have the same perspective as the patient.
The adolescent Hispanic male has been diagnosed with attention-deficit hyperactivity disorder (ADHD), and is taking methylphenidate (Ritalin). Even though the drug helps with focus and grades, the adolescent will not go to the school office at noon for his medication. Which statement best describes the result of the nurse's evaluation?
1. The adolescent has developed alternative coping mechanisms to increase his focus during classes.
2. The adolescent is fearful that this drug may be a "gateway drug" and he will abuse other substances.
3. The adolescent really does not need an additional dose of methylphenidate (Ritalin) at school.
4. The adolescent is embarrassed about having to take medicine at school; it is a social stigma.
Correct: 4
Rationale 1: Attention-deficit hyperactivity disorder is a brain-based disorder, and the primary treatment is medication; alternative coping mechanisms will not usually help to increase focus during classes.
Rationale 2: Appropriate treatment of attention-deficit hyperactivity disorder will result in less addiction to mood-altering substances, not more addiction.
Rationale 3: Methylphenidate (Ritalin) is a short-acting drug and doses must be administered about 4 hours apart, so the patient must receive a dose during school hours.
Rationale 4: Some patients believe that having to take drugs in school will cause them to be viewed as weak, unhealthy, or dependent. Patients can also perceive this as a social stigma.
The patient 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 or not to receive analgesia.
2. Inform the husband that he must sign a release of responsibility to avoid future litigation against the hospital.
3. Allow the request but inform the husband that the physician will make the final decision about analgesia.
4. Allow this request and be available in the event the request changes.
Correct: 4
Rationale 1: With some cultures, the husband makes the choices, not the wife.
Rationale 2: When cultural differences are allowed and supported, patients are not as likely to become involved in litigation.
Rationale 3: With some cultures, the husband makes the choices, not the physician.
Rationale 4: Nurses must allow and support cultural differences. The husband's decisions must be respected as long as patient safety is not involved, and it is not involved in this situation.
The African American patient has panic attacks, is suicidal, and is on an inpatient psychiatric unit. The psychiatrist orders sertraline (Zoloft) and clonazepam (Klonopin). The patient refuses the drugs; he requests to have herbs and African objects in his room to "remove the curse." What is the priority action by the nurse?
1. Allow the request without seeking further information from the patient.
2. Allow the request as long as the herbs and objects do not pose a safety risk for the patient or other patients.
3. Allow the request after the patient signs a release of responsibility to avoid litigation.
4. Allow the request after all members of the treatment team agree to it.
Correct: 2
Rationale 1: To allow an ethnic request without seeking further information about safety could jeopardize patient safety.
Rationale 2: Nurses must grant ethnic requests as long as the request does not pose a safety risk to the patient or others.
Rationale 3: There is no need for the patient to sign a release of responsibility to avoid litigation; if items pose a safety risk, they cannot be allowed on the unit.
Rationale 4: The treatment team does not need to agree to this request; the nurse can approve it as long as the items do not pose a safety risk.
The nurse is doing a holistic assessment on a patient prior to the initiation of anti-hypertensive medication. What will the best assessment include? (select all that apply).
1. Blood pressure
2. The biologic cause of the hypertension
3. Mood
4. Level of education
5. Belief in a higher power
Correct: 1, 3, 4, 5
Rationale 1: Holistic health care incorporates the whole patient to include the biological (blood pressure) dimension.
Rationale 2: The biologic cause of the hypertension focuses on a specific disease, its cause, and treatment; this is a medical model, not a holistic model.
Rationale 3: Holistic health care incorporates the whole patient to include the psychological (mood) dimension.
Rationale 4: Holistic health care incorporates the whole patient to include the sociocultural (level of education) dimension.
Rationale 5: Holistic health care incorporates the whole patient to include the spiritual (belief in a higher power) dimension.
The physician has prescribed a chemotherapeutic drug for the patient with cancer. This drug commonly causes loss of hair. The patient asks the nurse, "Will all of my hair fall out?" What is the most therapeutic response by the nurse?
1. "We are not really sure; applying an ice bag to your head may help."
2. "Don't worry, we can recommend an excellent wig company if need be."
3. "Yes, that is one of the expected side effects of this medication."
4. "It might. Have you discussed this with your physician?"
Correct: 3
Rationale 1: Ice bags can minimize hair loss with some patients, but the nurse is not honestly answering the patient's question.
Rationale 2: Telling a patient not to worry is one of the most non-therapeutic responses a nurse can make.
Rationale 3: The nurse must always be forthright in explaining drug actions and potential side effects; minimizing potential adverse effects can result in a distrust of the nurse.
Rationale 4: In this case, the nurse, not the physician, is responsible for answering the patient's questions.
The patient, who is an American Indian, has been admitted to the hospital for chemotherapy. At any given time, five family members are in the patient's room, which is private. The nurse tells the patient that according to hospital policy, only two visitors at a time are allowed. What does the best analysis by the nurse manager reveal about the nurse's action?
1. The nurse should have assessed the patient's preferences about how many family members she wanted to be present.
2. The nurse should have called the physician and obtained an order for additional family members to be present.
3. This was the correct action; the nurse was following protocol by informing the patient about hospital policy.
4. The nurse should have allowed the patient to have as many family members as she wanted to be present.
Correct: 1
Rationale 1: The nurse should have assessed the patient's preference about how many visitors she wanted in her room before so strictly interpreting the hospital rules.
Rationale 2: This situation could be resolved by the nurse; there is no need for a physician's order at this point.
Rationale 3: Many hospital rules, such as how many visitors are allowed, are flexible and do not have to be strictly interpreted; this patient is in a private room.
Rationale 4: The nurse must be realistic with regard to the number of family visitors the patient wants present; five family members is acceptable; twenty would be too many.
The public health nurse notices that several patients in the hypertension clinic have poorly controlled hypertension, even though they have been prescribed appropriate antihypertensive drugs. Which question will best enable the nurse to assess these patients?
1. "Does your religion allow the use of high blood pressure medication?"
2. "Do you think your high blood pressure is a problem?"
3. "Can you afford the high blood pressure medication?"
4. "Does your culture use herbs to treat high blood pressure?"
Correct: 3
Rationale 1: Religious beliefs could result in the patient not taking the medication, but the cost of the medication is more likely the problem.
Rationale 2: To ask a patient if they think hypertension is a problem should not be necessary; the nurse could eliminate this by appropriate medication education when the medication is prescribed for the patient.
Rationale 3: Once treatment is rendered, the cost of prescription drugs may be far too high for patients on limited incomes.
Rationale 4: The use of herbs may be important in the patient's culture, but the cost of the medication is more likely the problem.
The nurse is providing education about warfarin (Coumadin) to a patient of Asian ancestry. The nurse determines that learning has occurred when the patient makes which statement?
1. "I may need to have more frequent blood tests."
2. "I may need to have less frequent blood tests."
3. "I may need more medication than someone from a different ethnic group."
4. "I may need less medication than someone from a different ethnic group."
Correct: 4
Rationale 1: There is no need for patients of Asian ancestry to have more frequent blood tests than other patients..
Rationale 2: There is no need for patients of Asian ancestry to have less frequent blood tests.
Rationale 3: A patient of Asian ancestry may be a poor metabolizer of warfarin (Coumadin), so they will not require a higher dose.
Rationale 4: A patient of Asian ancestry may be a poor metabolizer of warfarin (Coumadin), so they will often require lower dosages.
The nurse is conducting a holistic assessment of a patient with alcoholism. What are the important questions to ask? (select all that apply)
1. "How is drinking alcohol viewed by your culture?"
2. "Have you ever attended Alcoholics Anonymous meetings?"
3. "Did you see your parents drinking alcohol when you were growing up?"
4. "Have you been in alcohol rehabilitation before now?"
5. "What blood relatives of yours are addicted to alcohol?"
Correct: 1, 3, 5
Rationale 1: Cultural questions are valid questions to ask during a holistic assessment.
Rationale 2: Participation in Alcoholics Anonymous refers to treatment and does not have relevance to a holistic assessment.
Rationale 3: Environmental questions are valid questions to ask during a holistic assessment.
Rationale 4: Participation in a rehabilitation program refers to treatment and does not have relevance to a holistic assessment.
Rationale 5: Biological questions are valid questions to ask during a holistic assessment.
All of the patients listed have cancer and are receiving chemotherapy. Which patient does the nurse evaluate as having the highest probability for a remission?
1. The patient with a support group of cancer survivors
2. The patient who is also seeing a psychiatrist for treatment of depression
3. The wealthy patient who can afford the best medical care available
4. The patient who is a former physician
Correct: 1
Rationale 1: Positive attitudes and high expectations toward therapeutic outcomes in the patient may influence the success of pharmacotherapy. The support group of cancer survivors would provide the best support and the highest probability for a positive outcome.
Rationale 2: Treatment for depression might help the outcome, but this patient would not have as high a probability for remission as the patient with another resource.
Rationale 3: A wealthy patient can afford the best medical care, but this patient may not have good psychosocial support.
Rationale 4: A former physician may have a sound knowledge base about cancer, but this patient might not have good psychosocial support.
The patient is receiving a beta-blocker medication. The nurse has done medication education and provided the patient with printed information to take home. During the next appointment, the nurse notes that the patient is not taking the medication properly. What is a therapeutic assessment question to ask this patient?
1. "Do I have to inform your physician about your noncompliance?"
2. "Why didn't you take your medicine as we talked about?"
3. "Are you able to read and comprehend the printed information?"
4. "Don't you understand how important it is to take the medicine?"
Correct: 3
Rationale 1: It is inappropriate to involve the physician before the nurse assesses the reason for noncompliance, and this question is threatening.
Rationale 2: Asking "why" questions put the patient on the defensive, and the nurse might not receive the most accurate answer.
Rationale 3: Many English-speaking patients do not have functional literacy, a basic ability to read, understand, and act on health information. The nurse should ask the patient about the ability to read and understand printed information.
Rationale 4: Being confrontational with a "don't you understand" question is as demeaning as asking a "why" question.
The African American patient had a myocardial infarction and is receiving atorvastatin (Lipitor). The nurse caring for the patient is Caucasian. The nurse assesses the patient's diet to be very high in fat. What is the best plan by the nurse to improve the patient's diet and reduce the risk for additional medications?
1. With the patient's permission, plan to ask an African American nurse to speak to him about a low-fat diet.
2. With the patient's permission, plan to discuss his diet with whomever prepares meals for his family.
3. Plan to give the patient information specific to African Americans about low-fat diets.
4. Plan to ask the physician for a consult by dietary services so a dietician can teach the patient about low-fat diets.
Correct: 2
Rationale 1: Asking the patient about having an African American nurse speak to him is racist and implies that a Caucasian nurse cannot understand the dietary needs of an African American patient.
Rationale 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.
Rationale 3: Providing information is a good idea, but the nurse must also teach the patient.
Rationale 4: At this point, a consult by dietary services is premature.
The patient is admitted to the hospital following an abortion, and she is septic. The physician orders antibiotics that the patient refuses stating, "I don't deserve them." The nurse providing care has anti-abortion beliefs. What is the best response by the nurse?
1. "I think you need to do what is best for you."
2. "You have a serious infection and really need the drug."
3. "It seems you think you should be punished because you had an abortion"
4. "I'll call your physician and let him know about your decision."
Correct: 2
Rationale 1: Telling the patient she needs to do what is best is inappropriate; the nurse knows she needs the drug.
Rationale 2: Telling the patient she needs the drug is providing the best care possible; this must be done even though the nurse's beliefs are different from the patient's beliefs.
Rationale 3: Telling the patient what she thinks is not appropriate.
Rationale 4: Calling the physician is inappropriate; the nurse knows the patient needs the drug.
A nurse is teaching a community group about holistic medicine. Which information should the nurse include about Western medicine? (select all that apply).
1. Western medicine focuses on the cause of disease.
2. Western medicine is not compatible with holistic medicine.
3. The patient is at the center of concern in Western medicine.
4. Disease is often viewed as a malfunction in a specific body system.
5. Western medicine may focus on disease treatment.
Correct: 1, 4, 5
Rationale 1: Western medicine often focuses on determining which disease is present and what caused it.
Rationale 2: Western medicine is compatible with holistic medicine, but this requires that those providing care remain mindful of the individuality of the patient.
Rationale 3: Disease and treatment are typically at the center of Western medicine.
Rationale 4: In Western medicine disease is often viewed as a specific malfunction of a body part.
Rationale 5: Western medicine often focuses on the treatment of a disease, not the care of the patient with the disease.
Which of the following best indicates an ethnic characteristic that can affect pharmacotherapy?
1. Genetic differences
2. Diet
3. Health beliefs
4. Alternative therapies
Correct: 1
Rationale 1: Ethnicity relates to biology and genetics.
Rationale 2: Diet is a cultural characteristic.
Rationale 3: Health belief is a cultural characteristic.
Rationale 4: Alternative therapies are cultural characteristics.
Which statement is accurate regarding gender and pharmacology?
1. Women tend to seek medical care earlier than men do.
2. Heart disease has traditionally been thought of as a woman’s disease.
3. Since the 1980s, the FDA has mandated that research studies include both male and female subjects.
4. Studies indicate that men and women suffer from Alzheimer’s disease in equal numbers.
Correct: 1
Rationale 1: Women are quicker to seek medical care than are men.
Rationale 2: Cardiac disease has traditionally been thought of as a men’s issue.
Rationale 3: In 1993, the FDA mandated that research studies include both male and female subjects.
Rationale 4: Studies indicate that more women than men suffer from Alzheimer’s disease.
Which statement regarding human DNA sequences is accurate?
1. Only 2% of human DNA is different among the different ethnicities.
2. Due to enzyme polymorphism, Hispanics are less likely to metabolize codeine to morphine.
3. Even though human genetic differences are small, significant differences can be seen with drug metabolism.
4. Asian Americans are the ethnic group known to be slow acetylators.
Correct: 3
Rationale 1: Human DNA differences of only 0.2% can produce significant differences in the way drugs are handled within the body.
Rationale 2: Asian Americans are less likely to metabolize codeine to morphine.
Rationale 3: Human DNA differences of only 0.2% can produce significant differences in the way drugs are handled within the body.
Rationale 4: Caucasians are known to be slow acetylators.
The nurse in the emergency department is caring for several patients from diverse cultures. Which statement shows the nurse's ability to provide culturally competent care? (select all that apply)
1. "I understand your religion prohibits blood transfusions. Would you consider nonblood alternatives?"
2. "I just want to make sure you and your spouse understand the risks as you consider the options."
3. "I don't really understand why you are afraid to take the medication. Do you have any questions I can answer to alleviate your fear?"
4. "I really don't understand why you won't consider an abortion. Your admission papers say you are an atheist."
5. "I'm not quite sure why the health care provider is giving you these prescriptions. You didn't get them filled the last time you were here."
Correct: 1, 2, 3
Rationale 1: This statement shows the nurse is respectful of religious beliefs and open to offering alternative treatment.
Rationale 2: This statement shows the nurse is accepting of patients' beliefs.
Rationale 3: This statement may encourage the patient to open up to the nurse about fears.
Rationale 4: This is a judgmental and insensitive comment. A culturally competent nurse is sensitive to the patient's spiritual beliefs or lack thereof.
Rationale 5: This statement does not consider social factors that may contribute to nonadherence.
The nurse manager would determine that a nurse understands culturally sensitive care if which statements are made? (select all that apply)
1. "Since all of our patients have the same illnesses, I sometimes get bored."
2. "I have been helping my patient understand how to choose foods from our diet menu."
3. "I am concerned because my patient needs sterile dressing changes but has no running water at home."
4. "My patient and I worked out a way to get her medications delivered to her at home."
5. "I invited a group from my church to come and sing hymns for our patients."
Correct: 2, 3, 4
Rationale 1: A nurse who believes that patients who have the same illness are alike is not seeing their psychosocial needs.
Rationale 2: Helping the patient cope and navigate through the hospital “culture” is a culturally sensitive action.
Rationale 3: Cultural sensitivity takes environment into consideration.
Rationale 4: Helping the patient cope and navigate through potential blockers to medication adherence is a culturally sensitive action.
Rationale 5: Imposing one’s own religious beliefs on others is not culturally sensitive.
A nurse administering medications to a variety of patients on a medical-surgical floor recognizes that which patients may need additional education about medication adherence? (select all that apply)
1. Fifty-year-old recently remarried male taking antihypertensive medication
2. Thirty-four-year-old female with family history of blood clots taking an estrogen oral contraceptive
3. Thirty-eight-year-old male recently started on an antidepressant
4. Twenty-eight-year-old female started on acne medication known to cause male-patterned hair growth
5. Seventy-eight-year-old female being treated for shingles
Correct: 1, 2, 3, 4
Rationale 1: Antihypertensive medications can cause impotence. This patient will need additional education about this possible side effect.
Rationale 2: Estrogen can cause an increased risk for thrombolytic events, especially in patients who have a positive family history.
Rationale 3: Taking an antidepressant may result in the man feeling weak, unhealthy, or dependent.
Rationale 4: Some acne medications cause increased hair growth in a male pattern, such as on the face. While controlling acne is a goal, the patient may not want the extra hair growth.
Rationale 5: There is no indication that treatment for shingles requires education in excess of that which is generally provided.
A patient asks the nurse why a medication prescribed by the provider "didn't do anything at all." Which statement by the nurse accurately describes how genetics influence drug action? (select all that apply)
1. "Genetic differences can result in significant differences in how each patient's body handles the same medication."
2. "Genetic differences can cause mutations in enzymes, changing the way they function. This can alter how the body metabolizes and excretes drugs."
3. "Because of genetic differences, medication may accumulate to toxic levels in one patient while in another patient may be inactivated before it can have a therapeutic effect."
4. "Genetic differences can be expressed as an alteration in the structure of an enzyme, which can cause a defective receptor and an allergic response to drugs."
5. "Genetic differences in patients who are biracial result in an allergic response to medications."
Correct: 1, 2, 3
Rationale 1: 99.8% of human DNA sequences are identical. The remaining 0.2% can account for significant differences in people's ability to handle medications.
Rationale 2: The structure of an enzyme is closely related to its function. A mutation can cause a change in the structure of the enzyme, resulting in a change in its function.
Rationale 3: When enzymes are functionally changed by genetics, metabolism and excretion can be altered, resulting in the drug either accumulating or being inactivated.
Rationale 4: Small changes in the structure of a protein may result in a defective receptor that will not accept the drug and the drug not having any therapeutic effect. This is not an allergic response.
Rationale 5: Genetic differences can result in mutations of enzymes or proteins, which may result in changes in function. Being of a certain race may predispose a patient to mutations and, therefore, uncommon responses to medication, but this does not mean the patient will have an allergic response to medications.
A home health nurse's patient caseload is ethnically diverse. Which interventions show understanding of cultural variables? (select all that apply)
1. Discussing cultural preferences for herbs and spices and possible alternatives when drug interactions are possible
2. Assessing the patient's response to acupuncture for pain
3. Discussing the patient's beliefs regarding treatment
4. Notifying the health care provider of the patient's intentions to consult with a medicine man for spiritual guidance
5. Removing the patient's collection of herbs to decrease the risk of an adverse effect when taken with Western medicine
Correct: 1, 2, 3
Rationale 1: It is important to assess the cultural use of herbs and spices and determine if there may be any interactions with prescribed medications.
Rationale 2: The nurse can assess the patient's response to acupuncture and interpret the effects on prescribed treatment with respect for the patient's culture.
Rationale 3: Cultures view health and wellness in different ways. An understanding of the patient's cultural beliefs allows the nurse to provide better support and guidance.
Rationale 4: As long as the medicine man does not "prescribe" any herbs, the nurse does not have to discuss this with the provider.
Rationale 5: The nurse need not remove the herbs but rather should discuss possible adverse effects when the herbs are mixed with prescribed medications.
The nurse in charge of a clinical study welcomes the participants in an open forum. One patient is surprised that there are men and women from several ethnic groups. The nurse tells the group that in the past, ethnic variables were largely unknown or ignored for what reasons? (select all that apply)
1. Clinical trials failed to include ethnically diverse subjects.
2. Clinical trials comprised mostly Caucasian males.
3. Little attention was focused on identifying the different effects drugs had on various ethnic groups.
4. Research proved there were no differences among ethnic groups.
5. The large majority of clinical trials included Caucasian females.
Correct: 1, 2, 3
Rationale 1: There was a lack of ethnic diversity in early clinical trials.
Rationale 2: Until recently, clinical trials comprised mostly Caucasian males.
Rationale 3: Little attention was focused on identifying the differences in pharmacologic effects in diverse ethnic groups.
Rationale 4: There was insufficient research to show differences because little attention was focused on these differences.
Rationale 5: The large majority of clinical trials excluded females.
The nurse is assessing several patients. For which patient does assessment reveal a psychosocial history that may affect the patient's outcome? (select all that apply)
1. Older adult who recently suffered a stroke, has an unsteady gait, and lives in a two-story home
2. Middle-aged patient with Down syndrome living in a group home
3. Recently divorced mother of three children with breast cancer
4. Sixteen-year-old requesting birth control without parental consent
5. Seven-year-old with asthma in a foster care home
Correct: 1, 2, 3
Rationale 1: This patient may not be able to return to a home that requires climbing stairs.
Rationale 2: A patient with Down syndrome needs additional care to ensure that treatment outcome is successful.
Rationale 3: This patient may be the family's sole provider and may have financial concerns.
Rationale 4: Many teens seek contraception without their parents' consent. This should not have a negative impact on outcome.
Rationale 5: Residing in foster care should not have a negative impact on outcome.