Silvestri Chapter 45 Ed#569

Silvestri, 3/e, ISBN 1-1460-0052-6 Chapter 045 (edited file)—"Endocrine Medications" 10/14/08, Page 1 of 11, 0 Figure(s), 2 Table(s), 12 Box(es)

45: Endocrine Medications PRACTICE QUESTIONS 1. Somatren (Protropin) is administered to a client with pituitary dwarfism. The expected therapeutic effect of this medication is to: 1. Promote weight gain 2. Stimulate linear growth 3. Increase bone density 4. Decrease the mobilization of fats Answer: 2 Rationale: Protropin is a growth stimulator used in the long-term treatment of growth failure resulting from growth hormone deficiency. It stimulates linear growth, increases the number and size of muscle cells, and red cell mass. It affects carbohydrate metabolism by antagonizing the action of insulin, increasing mobilization of fats, and increasing cellular protein synthesis. Test-Taking Strategy: Use the client diagnosis in the question to assist in the process of elimination in answering the question. Note the relationship between “dwarfism” in the question and “growth” in the correct option. Review the action of this medication if you had difficulty with this question. Level of Cognitive Ability: Analysis Client Needs: Physiological Integrity Integrated Process: Nursing Process/Evaluation Content Area: Pharmacology Reference: Hodgson, B., & Kizior, R. (2005). Saunders nursing drug handbook 2005. Philadelphia: W.B. Saunders, p. 981. 2. A nurse is monitoring a client receiving desmopressin (DDAVP). Which of the following, if noted in the client, would indicate an adverse effect of the medication? 1. Increased urination 2. Weight loss 3. Drowsiness 4. Insomnia Answer: 3 Rationale: Water intoxication or hyponatremia is an adverse reaction to DDAVP. Early signs include drowsiness, listlessness, and headache. Decreased urination, rapid weight gain, confusion, seizures, and coma may also occur in overhydration. Test-Taking Strategy: Use the process of elimination. Knowledge that this medication is used in the treatment of diabetes insipidus will assist in eliminating options 1 and 2. Recalling the action of the medication will assist you in determining that water intoxication is an adverse reaction. This thought process will assist in directing you to option 3. Review the adverse reactions related to this medication if you had difficulty with this question. Level of Cognitive Ability: Analysis Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection Content Area: Pharmacology

Silvestri, 3/e, ISBN 1-1460-0052-6 Chapter 045 (edited file)—"Endocrine Medications" 10/14/08, Page 2 of 11, 0 Figure(s), 2 Table(s), 12 Box(es)

Reference: Hodgson, B., & Kizior, R. (2005). Saunders nursing drug handbook 2005. Philadelphia: W.B. Saunders, p. 303. 3. A nurse reinforces instructions to a client taking levothyroxine (Synthroid). The nurse determines that the teaching was effective if the client states that he or she will take the medication: 1. With food 2. On an empty stomach 3. At bed time 4. At lunch time Answer: 2 Rationale: Oral doses of levothyroxine should be taken on an empty stomach to enhance absorption. The medication should be taken in the morning before breakfast. Test-Taking Strategy: Use the process of elimination. Eliminate options 1 and 4 first because they are similar. From the remaining options, recalling the purpose of the medication and that it is administered in the morning will direct you to option 2. Review this medication if you had difficulty with this question. Level of Cognitive Ability: Comprehension Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process/Evaluation Content Area: Pharmacology References: Hodgson, B., & Kizior, R. (2005). Saunders nursing drug handbook 2005. Philadelphia: W.B. Saunders, p. 632. McKenry, L., & Salerno, E. (2003). Mosby’s pharmacology in nursing (21st ed.). St. Louis: Mosby, p. 842. 4. Thyroid replacement therapy is prescribed for a client diagnosed with hypothyroidism. The client asks the nurse when the medication will no longer be needed. The nurse makes which response to the client? 1. “You will need to ask your physician.” 2. “Most clients require medication therapy for about 1 year.” 3. “It depends on the results of the laboratory values.” 4. “The medication will need to be continued for life.” Answer: 4 Rationale: For most hypothyroid clients, replacement therapy must be continued for life. Treatment provides symptomatic relief but does not produce a cure. The client should be told that although therapy will improve symptoms, these improvements do not constitute a reason to interrupt or discontinue the medication. Test-Taking Strategy: Use the process of elimination. Recalling the physiology associated with hypothyroidism will direct you to option 4. If you are unfamiliar with this disorder and the medication therapy associated with it, review this content. Level of Cognitive Ability: Application Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process/Implementation Content Area: Pharmacology Reference: Hodgson, B., & Kizior, R. (2005). Saunders nursing drug handbook 2005.

Silvestri, 3/e, ISBN 1-1460-0052-6 Chapter 045 (edited file)—"Endocrine Medications" 10/14/08, Page 3 of 11, 0 Figure(s), 2 Table(s), 12 Box(es)

Philadelphia: W.B. Saunders, p. 633. 5. A nurse reinforces medication instructions to a client taking levothyroxine (Synthroid). The nurse instructs the client to notify the physician if which of the following occurs? 1. Cold intolerance 2. Tremors 3. Excessively dry skin 4. Fatigue Answer: 2 Rationale: Excessive doses of levothyroxine can produce signs and symptoms of hyperthyroidism (thyrotoxicosis). These include tachycardia, angina, tremors, nervousness, insomnia, hyperthermia, heat intolerance, and sweating. The client should be instructed to notify the physician if these occur. Options 1, 3, and 4 are signs of hypothyroidism. Test-Taking Strategy: Use the process of elimination, recalling the symptoms associated with hypothyroidism, the purpose of administering levothyroxine, and the effects of the medication. Options 1, 3, and 4 are symptoms related to hypothyroidism. Review the adverse effects of the medication if you are unfamiliar with it. Level of Cognitive Ability: Application Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process/Implementation Content Area: Pharmacology Reference: Hodgson, B., & Kizior, R. (2005). Saunders nursing drug handbook 2005. Philadelphia: W.B. Saunders, p. 633. 6. A nurse reviews the health record of a client seen in the physician’s office and noted that the client is taking propylthiouracil (PTU) daily. The nurse suspects that the client has a history of: 1. Cushing’s syndrome 2. Addison’s disease 3. Myxedema 4. Graves’ disease Answer: 4 Rationale: PTU inhibits thyroid hormone synthesis and is used to treat hyperthyroidism or Graves’ disease. Myxedema indicates hypothyroidism. Cushing’s syndrome and Addison’s disease are disorders related to adrenal function. Test-Taking Strategy: Knowledge regarding the action of the medication and the treatment measures for Graves’ disease is required to answer the question. Remember, PTU inhibits thyroid hormone synthesis and is used to treat hyperthyroidism or Graves’ disease. If you are unfamiliar with either of these, review this content. Level of Cognitive Ability: Analysis Client Needs: Physiological Integrity Integrated Process: Nursing Process/Data Collection Content Area: Pharmacology References: Hodgson, B., & Kizior, R. (2005). Saunders nursing drug handbook 2005. Philadelphia: W.B. Saunders, p. 904. McKenry, L., & Salerno, E. (2003). Mosby’s pharmacology in nursing (21st ed.). St. Louis: Mosby, p. 825.

Silvestri, 3/e, ISBN 1-1460-0052-6 Chapter 045 (edited file)—"Endocrine Medications" 10/14/08, Page 4 of 11, 0 Figure(s), 2 Table(s), 12 Box(es)

7. A nurse is reinforcing instructions to a client regarding the administration of lypressin (Diapid). The nurse instructs the client that the medication will be taken by which of the following routes? 1. Oral 2. Subcutaneous 3. Intranasal 4. Intramuscular Answer: 3 Rationale: Lypressin is administered by the intranasal route. It is used for diabetes insipidus. The usual adult dosage is one or two sprays into each nostril four times daily. Options 1, 2, and 4 are incorrect. Test-Taking Strategy: Knowledge that lypressin is administered by the nasal route is required to answer the question. Review this medication if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process/Implementation Content Area: Pharmacology Reference: McKenry, L., & Salerno, E. (2003). Mosby’s pharmacology in nursing (21st ed.). St. Louis: Mosby, p. 833. 8. A client is seen by the physician for complaints of fatigue, a lack of energy, constipation, and depression. Following diagnostic studies, hypothyroidism is diagnosed. Levothyroxine (Synthroid) is prescribed. The nurse tells the client that the primary expected outcome of the medication is to: 1. Increase energy levels. 2. Achieve normal thyroid hormone levels. 3. Increase blood glucose levels. 4. Alleviate depression. Answer: 2 Rationale: Laboratory determination of the serum thyroid-stimulating hormone level (TSH) is an important means of evaluation of therapy with levothyroxine. Effective therapy will cause the elevated TSH levels to decrease. These levels will begin their decline within hours of the onset of therapy and will continue to drop as plasma levels of thyroid hormone build up. If an adequate dosage is established, TSH levels will remain suppressed for the duration of the therapy. Although energy levels are expected to increase, the primary expected outcome is measured by thyroid hormone levels. Options 3 and 4 are unrelated to this medication. Test-Taking Strategy: Note the key words, primary and expected outcome. Relate the diagnosis of hypothyroidism with thyroid hormone levels in the correct option. If you had difficulty with this question, review the therapeutic effects of levothyroxine. Level of Cognitive Ability: Application Client Needs: Physiological Integrity Integrated Process: Nursing Process/Implementation Content Area: Pharmacology Reference: Hodgson, B., & Kizior, R. (2005). Saunders nursing drug handbook 2005. Philadelphia: W.B. Saunders, p. 632.

Silvestri, 3/e, ISBN 1-1460-0052-6 Chapter 045 (edited file)—"Endocrine Medications" 10/14/08, Page 5 of 11, 0 Figure(s), 2 Table(s), 12 Box(es)

9. Propylthiouracil (PTU) is prescribed for a client with hyperthyroidism and the nurse reinforces instructions to the client regarding the medication. The nurse informs the client to notify the physician if which of the following signs occur? 1. Drowsiness 2. Sore throat 3. Polyuria 4. Dry mouth Answer: 2 Rationale: An adverse effect of PTU is agranulocytosis. The client needs to be informed of the early signs of this adverse effect, which includes fever or sore throat. Drowsiness is an occasional side effect of the medication. Polyuria and dry mouth are unrelated to this medication. Test-Taking Strategy: Use the process of elimination. Recalling that agranulocytosis is an adverse effect of PTU will direct you to option 2. Review this medication if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process/Implementation Content Area: Pharmacology Reference: McKenry, L., & Salerno, E. (2003). Mosby’s pharmacology in nursing (21st ed.). St. Louis: Mosby, p. 848. 10. A client is scheduled for subtotal thyroidectomy. Iodine solution (Lugol solution) is prescribed. The nurse understands that the therapeutic effect of this medication is to: 1. Increase thyroid hormone production. 2. Suppress thyroid hormone production. 3. Replace thyroid hormone. 4. Prevent the oxidation of iodide. Answer: 2 Rationale: Lugol solution is administered to hyperthyroid individuals in preparation for thyroidectomy to suppress thyroid function. Initial effects develop within 24 hours; peak effects develop in 10 to 15 days. Options 1, 3, and 4 are incorrect. Test-Taking Strategy: Use the process of elimination. Eliminate options 1 and 3 first because they are similar. From the remaining options, select option 2 because of its relationship to the issue of the question. If you had difficulty with this question, review the purpose of this medication. Level of Cognitive Ability: Comprehension Client Needs: Physiological Integrity Integrated Process: Nursing Process/Evaluation Content Area: Pharmacology Reference: McKenry, L., & Salerno, E. (2003). Mosby’s pharmacology in nursing (21st ed.). St. Louis: Mosby, p. 845. 11. A nurse reinforces instructions to the client taking fludrocortisone (Florinef). The nurse tells the client to notify the physician if which of the following occurs?

Silvestri, 3/e, ISBN 1-1460-0052-6 Chapter 045 (edited file)—"Endocrine Medications" 10/14/08, Page 6 of 11, 0 Figure(s), 2 Table(s), 12 Box(es)

1. Weight loss 2. Nausea 3. Swelling of the feet 4. Fatigue Answer: 3 Rationale: Excessive doses of fludrocortisone cause retention of sodium and water and excessive excretion of potassium, resulting in expansion of blood volume, hypertension, cardiac enlargement, edema, and hypokalemia. The client needs to be informed about the signs of sodium and water retention, such as unusual weight gain or swelling of the feet or lower legs. If these signs occur, the physician needs to be notified. Test-Taking Strategy: Use the process of elimination. Recalling that fludrocortisone can cause water retention will direct you to option 3. If you are unfamiliar with the adverse effects associated with this medication, review this content. Level of Cognitive Ability: Application Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process/Implementation Content Area: Pharmacology Reference: Hodgson, B., & Kizior, R. (2005). Saunders nursing drug handbook 2005. Philadelphia: W.B. Saunders, p. 445. 12. Calcium carbonate (Os-Cal 500) is prescribed for a client with hypocalcemia. The nurse tells the client to take the medication: 1. With meals 2. One hour after meals 3. One hour before meals 4. One hour before breakfast Answer: 2 Rationale: The client should be instructed to take oral calcium 30 to 60 minutes after meals to promote absorption. The client should take the medication with a full glass of water. Test-Taking Strategy: Use the process of elimination. Eliminate options 3 and 4 first because they are similar. From the remaining options, it is necessary to know that this medication is taken after meals. Review this medication if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Physiological Integrity Integrated Process: Teaching/Learning Content Area: Pharmacology Reference: (2005). Mosby’s 2005 drug consult for nurses. St. Louis: Mosby, p. 1279. 13. Calcitriol (Rocaltrol) is prescribed for the client with hypocalcemia and the nurse provides dietary instructions to the client. Which food item would the nurse instruct the client to avoid while taking this medication? 1. Oysters 2. Milk 3. Whole-grain cereals 4. Sardines Answer: 3

Silvestri, 3/e, ISBN 1-1460-0052-6 Chapter 045 (edited file)—"Endocrine Medications" 10/14/08, Page 7 of 11, 0 Figure(s), 2 Table(s), 12 Box(es)

Rationale: The client taking an antihypocalcemic medication should be instructed to avoid eating foods that can suppress calcium absorption. These foods include Swiss chard, beets, bran, and whole-grain cereals. Test-Taking Strategy: Use the process of elimination. Note that the client’s diagnosis is “hypocalcemia” and note the key word, avoid. Eliminate options 1 and 4 first because they are similar. From the remaining options, recalling the food items that can suppress calcium absorption will direct you to option 3. Review these foods if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process/Implementation Content Area: Pharmacology Reference: Hodgson, B., & Kizior, R. (2004). Saunders nursing drug handbook 2004. Philadelphia: W.B. Saunders, p. 1117. 14. A daily dose of prednisone (Deltasone) is prescribed for a client. A nurse provides instructions to the client regarding administration of the medication and tells the client that the best time to take this medication is: 1. At bedtime 2. At noon 3. Early morning 4. Any time, at the same time, each day Answer: 3 Rationale: Glucocorticoids should be administered before 9 AM, and the client should be instructed to do so. Administration at this time helps minimize adrenal insufficiency and mimics the burst of glucocorticoids released naturally by the adrenals each morning. Test-Taking Strategy: Knowledge regarding the administration of glucocorticoids is required to answer this question. Remember, glucocorticoids should be administered before 9 AM. If you had difficulty with this question, review the guidelines associated with administering glucocorticoids. Level of Cognitive Ability: Application Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process/Implementation Content Area: Pharmacology Reference: Hodgson, B., & Kizior, R. (2005). Saunders nursing drug handbook 2005. Philadelphia: W.B. Saunders, p. 883. 15. Sildenafil citrate (Viagra) is prescribed to treat a client with erectile dysfunction. A nurse reviews the client's medical record and would question the prescription if which of the following is noted in the client's history? 1. Neuralgia 2. Use of nitroglycerin 3. Use of multivitamins 4. Insomnia Answer: 2 Rationale: Sildenafil citrate (Viagra) enhances the vasodilation effect of nitric oxide in the

Silvestri, 3/e, ISBN 1-1460-0052-6 Chapter 045 (edited file)—"Endocrine Medications" 10/14/08, Page 8 of 11, 0 Figure(s), 2 Table(s), 12 Box(es)

corpus cavernosus of the penis, thus sustaining an erection. Because of the effect of the medication, it is contraindicated with concurrent use of organic nitrates and nitroglycerin. It is not contraindicated with the use of vitamins. Neuralgia and insomnia are side effects of the medication. Test-Taking Strategy: Use the process of elimination and note the key words, would question the prescription. Recalling the action of the medication will direct you to option 2. If you had difficulty with this question, review the contraindications associated with the use of this medication. Level of Cognitive Ability: Analysis Client Needs: Physiological Integrity Integrated Process: Nursing Process/Implementation Content Area: Pharmacology Reference: (2005). Mosby’s 2005 drug consult for nurses. St. Louis: Mosby, p. 1358. 16. A nurse is teaching the client how to mix Regular insulin and NPH insulin in the same syringe. Which of the following actions, if performed by the client, would indicate the need for further teaching? 1. Injects air into NPH insulin vial first 2. Injects the amount of air equal to the desired dose of insulin into the vial 3. Withdraws the NPH insulin first 4. Withdraws the Regular insulin first Answer: 3 Rationale: When preparing a mixture of Regular insulin with another insulin preparation, the Regular insulin should be drawn into the syringe first. This sequence will avoid contaminating the vial of Regular insulin with insulin of another type. Options 1, 2, and 3 are correct. Test-Taking Strategy: Use the process of elimination and note the key words, need for further teaching. These words indicate a false response question and that you need to select the incorrect client statement. Recalling the appropriate method of preparing insulin for injection will direct you to option 3. Review this procedure if you had difficulty with this question. Level of Cognitive Ability: Comprehension Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Content Area: Pharmacology References: Black, J., & Hawks, J. (2005). Medical-surgical nursing: Clinical management for positive outcomes (7th ed.). Philadelphia: W.B. Saunders, p. 1264. Hodgson, B., & Kizior, R. (2005). Saunders nursing drug handbook 2005. Philadelphia: W.B. Saunders, pp. 570-571. McKenry, L., & Salerno, E. (2003). Mosby’s pharmacology in nursing (21st ed.). St. Louis: Mosby, p. 870. 17. A nurse is reinforcing home care instructions to a client recently diagnosed with diabetes mellitus. The client is taking NPH insulin daily and asks the nurse how to store the unopened vials of insulin. The nurse tells the client to: 1. Freeze the insulin. 2. Refrigerate the insulin. 3. Keep the insulin at room temperature.

Silvestri, 3/e, ISBN 1-1460-0052-6 Chapter 045 (edited file)—"Endocrine Medications" 10/14/08, Page 9 of 11, 0 Figure(s), 2 Table(s), 12 Box(es)

4. Keep in a dark, dry place. Answer: 2 Rationale: Unopened vials of insulin should be stored under refrigeration until needed. Vials should not be frozen. Open vials in use may be kept at room temperature and should be kept away from heat and direct light. Test-Taking Strategy: Use the process of elimination and note the key word, store, in the question. Remembering that insulin should not be frozen will assist in eliminating option 1. Eliminate options 3 and 4 first because they are similar and should be eliminated. Review client teaching points related to insulin if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Content Area: Pharmacology References: Hodgson, B., & Kizior, R. (2005). Saunders nursing drug handbook 2005. Philadelphia: W.B. Saunders, p. 570. McKenry, L., & Salerno, E. (2003). Mosby’s pharmacology in nursing (21st ed.). St. Louis: Mosby, p. 868. 18. A client with diabetes mellitus is self-administering NPH insulin from a vial that is kept at room temperature. The client asks the nurse about the length of time an unrefrigerated vial of insulin will maintain its potency. The appropriate response is which of the following? 1. Two weeks 2. One month 3. Two months 4. Six months Answer: 2 Rationale: An unrefrigerated insulin vial will maintain its potency for up to 1 month. Direct sunlight and heat must be avoided. Test-Taking Strategy: Note the key word, unrefrigerated, to assist in directing you to the correct option. Review the concepts related to insulin stability if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process/Implementation Content Area: Pharmacology References: McKenry, L., & Salerno, E. (2003). Mosby’s pharmacology in nursing (21st ed.). St. Louis: Mosby, p. 868. 19. Lispro insulin (Humalog), a rapid-acting form of insulin, is prescribed for a client. The nurse instructs the client to administer the insulin: 1. Immediately before eating 2. 30 minutes before eating 3. 45 minutes before eating 4. 60 minutes before eating Answer: 1 Rationale: The effect of lispro insulin begins within 5 minutes of subcutaneous injection and persists for 2 to 4 hours. Lispro insulin acts more rapidly than Regular insulin but has a shorter

Silvestri, 3/e, ISBN 1-1460-0052-6 Chapter 045 (edited file)—"Endocrine Medications" 10/14/08, Page 10 of 11, 0 Figure(s), 2 Table(s), 12 Box(es)

duration of action. Because of its rapid onset, it can be administered immediately before eating. In contrast, Regular insulin is generally administered 30 to 60 minutes before meals. Test-Taking Strategy: Use the process of elimination. Noting the key words rapid-acting will assist in eliminating options 3 and 4. From the remaining options, remember that the question is asking about lispro, not Regular, insulin. Review this type of insulin if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Content Area: Pharmacology Reference: Black, J., & Hawks, J. (2005). Medical-surgical nursing: Clinical management for positive outcomes (7th ed.). Philadelphia: W.B. Saunders, pp. 1254-1255. 20. Tolbutamide (Orinase) is prescribed for the client with diabetes mellitus. The nurse instructs the client to avoid which of the following while taking this medication? 1. Carbonated beverages 2. Organ meats 3. Alcohol 4. Whole-grain cereals Answer: 3 Rationale: When alcohol is combined with tolbutamide, a disulfiram-like reaction may occur. This syndrome includes flushing, palpitations, and nausea. Also, alcohol can potentiate the hypoglycemic effects of tolbutamide. Clients must be warned about alcohol consumption while taking this medication. Test-Taking Strategy: Use the process of elimination. Eliminate options 1, 2, and 4 because these food items are allowed in a diabetic diet. From the remaining options, remembering that alcohol can affect the action of many medications will assist in directing you to option 3. Review this medication if you had difficulty with this question. Level of Cognitive Ability: Application Client Needs: Health Promotion and Maintenance Integrated Process: Teaching/Learning Content Area: Pharmacology Reference: McKenry, L., & Salerno, E. (2003). Mosby’s pharmacology in nursing (21st ed.). St. Louis: Mosby, p. 1018. 21. A client with diabetes mellitus is preparing for discharge from the hospital and tells the nurse that syringes prefilled with NPH and Regular insulin will be prepared by a home care nurse who will be visiting the client. The client asks the nurse how often the home care nurse will need to visit to prefill syringes. Considering the stability of insulin, the nurse tells the client that how many prefilled syringes can be prepared by the home care nurse? Answer: 7 Rationale: Mixtures of insulin in prefilled syringes should be stored in a refrigerator, where they will be stable for 1 week. The syringe should be stored vertically, with the needle pointing up, to avoid clogging the needle. Prior to administration, the syringe should be agitated gently to resuspend the insulin. Test-Taking Strategy: It is necessary to know the concepts related to insulin stability and storage

Silvestri, 3/e, ISBN 1-1460-0052-6 Chapter 045 (edited file)—"Endocrine Medications" 10/14/08, Page 11 of 11, 0 Figure(s), 2 Table(s), 12 Box(es)

to answer this question. Review these concepts if you are unfamiliar with the principles related to prefilling insulin syringes. Level of Cognitive Ability: Application Client Needs: Health Promotion and Maintenance Integrated Process: Nursing Process/Implementation Content Area: Pharmacology Reference: (2005). Mosby’s 2005 drug consult for nurses. St. Louis: Mosby, p. 1107.