TEST BANK FOR PHARMACOLOGY 10TH EDITION BY MCCUISTION; A Patient-Centered Nursing Process Approach 10TH EDITION Chapter 01: The Nursing Process and
... [Show More] Patient-Centered Care MULTIPLE CHOICE
1. The nursing process is a five-step decision-making approach that includes all of the following steps, EXCEPT: a. Assessment b. Patient problem c. Planning d. Right Drug
ANS: D The nursing process is a five-step decision-making approach that includes: 1) assessment, 2)
patient problem, 3) planning, 4) implementation, and 5) evaluation. “Right drug” is one of the “Six Rights” of medication administration. DIF: Cognitive Level: Understanding (Comprehension)
TOP: Nursing Process: Planning MSC: NCLEX: Management of Care
2. The nurse is using data collected to set goals or expected outcomes and interventions that address the patient’s problems. Which step of the nursing process is the nurse applying? a. Assessment b. Patient problem c. Planning Evaluation
ANS: C During the planning phase, the nurse uses the data collected to set goals or expected outcomes
and interventions which address the patient’s problems. The data was collected during the “Assessment” and “Patient problem” steps. During the “Evaluation” phase the nurse would determine whether the goals and objectives set during the planning phase were met.
DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Nursing Intervention MSC: NCLEX: Management of Care
3. A 5-year-old child with type 1 diabetes mellitus has had repeated hospitalizations for episodes of hyperglycemia. The parents tell the nurse that they can’t keep track of everything that has to be done to care for their child. The nurse reviews medications, diet, and symptom management with the parents and draws up a daily checklist for the family to use. These activities are completed in which step of the nursing process? a. Assessment b. Planning c. Implementation d. Evaluation
ANS: C
The implementation phase is the part of the nursing process in which the nurse provides education, drug administration, patient care, and other interventions necessary to assist the patient in accomplishing established medication goals.
1 | P a g eDIF: Cognitive Level: Understanding
(Comprehension) TOP: Nursing Process: Nursing
Intervention
MSC: NCLEX: Management of Care
4. The nurse is preparing to administer a medication and reviews the patient’s chart for
drug allergies, serum creatinine, and blood urea nitrogen (BUN) levels. The nurse’s actions
are reflective of which phase of the nursing process?
a. Assessment
b. Evaluation
c. Implementation
d. Planning
ANS: A
Assessment involves gathering information about the patient and the drug, including any
previous use of the drug.
DIF: Cognitive Level: Understanding (Comprehension)
TOP: Nursing Process: Assessment
MSC: NCLEX: Management of Care
5. Which assessment is categorized as objective data?
a. A list of herbal supplements regularly used
b. Lab values associated with the drugs the patient is taking
c. The ages and relationship to the patient of all household members
d. Usual dietary patterns and food intake
ANS: B
Objective data are measured and detected by another person and would include lab values.
The other examples are subjective data.
DIF: Cognitive Level: Understanding (Comprehension)
TOP: Nursing Process: Assessment
MSC: NCLEX: Management of Care
6. The nurse reviews a patient’s database and learns that the patient lives alone, is forgetful,
and does not have an established routine. The patient will be sent home with three new
medications to be taken at different times of the day. The nurse develops a daily medication
chart and enlists a family member to put the patient’s pills in a pill organizer. This is an
example of which phase of the nursing process?
a. Assessment
b. Evaluation
c. Implementation
d. Planning
ANS: C
The implementation phase involves education and patient care in order to assist the patient
to accomplish the goals of treatment.
DIF: Cognitive Level: Applying
(Application) TOP: Nursing Process: Nursing
Intervention
MSC: NCLEX: Management of Care
7. A patient who is hospitalized for chronic obstructive pulmonary disease (COPD) wants to go
home. The nurse and the patient discuss the patient’s situation and decide that the patient
may go home when able to perform self-care without dyspnea and hypoxia. This is an example
of which phase of the nursing process?
a. Assessment
2 | P a g eb. Evaluation
c. Implementation
d. Planning
ANS: D
Planning involves goal setting, which, for this patient, means being able to perform self-care
activities without dyspnea and hypoxia.
DIF: Cognitive Level: Understanding (Comprehension)
Planning MSC: NCLEX: Management of Care
TOP: Nursing Process:
8. A patient will be sent home with a metered-dose inhaler, and the nurse is providing teaching.
Which is a correctly written goal for this process?
a. The nurse will demonstrate the correct use of a metered-dose inhaler to the patient.
b. The nurse will teach the patient how to administer medication with a metered-
dose inhaler.
c. The patient will know how to self-administer the medication using the
metered-dose inhaler.
d. The patient will independently administer the medication using the metered-
dose inhaler at the end of the session.
ANS: D
Goals must be patient-centered and clearly state the outcome with a reasonable deadline and
should identify components for evaluation.
DIF: Cognitive Level: Applying (Application)
Planning MSC: NCLEX: Management of Care
TOP: Nursing Process:
9. The nurse is developing a plan of care for a patient who has chronic lung disease and hypoxia.
The patient has been admitted for increased oxygen needs above a baseline of 2 L/min. The
nurse develops a goal stating, “The patient will have oxygen saturations of >95% on room air
at the time of discharge from the hospital.” What is wrong with this goal?
a. It cannot be evaluated.
b. It is not measurable.
c. It is not patient-centered.
d. It is not realistic.
ANS: D
This goal is not realistic because the patient is not usually on room air and should not be
expected to attain that goal by discharge from this hospitalization.
DIF: Cognitive Level: Applying (Application)
Planning MSC: NCLEX: Management of Care
TOP: Nursing Process:
10. The nurse is developing a teaching plan for an elderly patient who will begin taking an
antihypertensive drug that causes dizziness and orthostatic hypotension. Which patient
problem documented by the nurse is appropriate for this patient?
a. Deficient knowledge related to drug side effects
b. Ineffective health maintenance related to age
c. Readiness for enhanced knowledge related to medication side effects
d. Risk for injury related to side effects of the medication
ANS: D
This patient has an increased risk for injury because of drug side effects, so this is an
appropriate patient problem to direct the type of care and follow-up the patient will receive.
DIF: Cognitive Level: Applying
(Application) TOP: Nursing Process: Nursing
Diagnosis MSC: NCLEX: Management of
3 | P a g eCare
11. An older patient must learn to administer a medication using a device that requires manual
dexterity. The patient becomes frustrated and expresses lack of self-confidence in performing
this task. Which action will the nurse perform next?
a. Ask the patient to keep trying until the skill is learned.
b. Provide written instructions with illustrations showing each step of the skill.
c. Schedule multiple sessions and practice each step separately.
d. Teach the procedure to family members who can administer the medication for the
patient.
ANS: C
Nurses should be sensitive to patient’s level of frustration when teaching skills. In this case,
breaking the steps down into individual parts will help with this patient’s frustration level.
DIF: Cognitive Level: Applying (Application)
Planning MSC: NCLEX: Management of Care
TOP: Nursing Process:
12. A school-age child will begin taking a medication to be administered at 5 mL three times
daily. The child’s parent tells the nurse that, with a previous use of the drug, the child
repeatedly forgot to bring the medication home from school, resulting in missed evening
doses. What will the nurse recommend?
a. Asking the provider if the medication may be taken before school, after school,
and at bedtime
b. Putting a note on the child’s locker to encourage the child to take responsibility for
medication administration
c. Asking the provider if 7.5 mL may be taken in the morning and 7.5 mL may be
taken in the evening so that the correct amount is given daily
d. Taking the noon dose to school every day and giving it to the school nurse to
administer
ANS: C
For busy families with school-age children, it may be necessary to adjust the medication
schedule to one that fits their schedule. The nurse should ask the provider if a revised schedule
is possible. In this case, the most effective revised schedule would involve not taking the
medication while at school. Putting a note on the locker is not likely to be effective. It is not
correct to adjust the dose.
DIF: Cognitive Level: Applying (Application)
TOP: Nursing Process: Nursing
Intervention/Planning MSC: NCLEX: Management of
Care
13. A high-school student regularly forgets to use a twice-daily inhaled corticosteroid to prevent
asthma flares and is repeatedly admitted to the hospital. The child’s parent tells the nurse
that the child has been told that forgetting to take the medication causes frequent
hospitalizations. The nurse will:
a. encourage the child to take responsibility for taking the medication.
b. reinforce the need to take prescribed medications to avoid hospitalizations.
c. suggest putting the inhaler with the child’s toothbrush to use before brushing teeth.
d. suggest that the child’s parents administer the medication to increase compliance.
ANS: C
It is important to empower patients to take responsibility for managing medications. Putting
the medication with the toothbrush can help this child remember to use it. Telling the child to
take medications and reminding the child that failure to do so results in hospitalization is not
working. Asking the child’s parents to administer the medication does not empower the
4 | P a g eadolescent to take responsibility.
DIF: Cognitive Level: Applying (Application)
TOP: Nursing Process: Planning/Nursing
Intervention MSC: NCLEX: Management of Care
14. An adolescent patient who has acne is given a regimen of topical medications and an oral
antibiotic that generally clears up lesions to fewer than 10 within 6 to 8 weeks. At a 2-month
follow-up, the patient continues to have more than 25 lesions. The child’s parent affirms that
the child is using the medications as prescribed. Which evaluation statement is correct for this
patient?
a. “Goal of fewer than 10 lesions in 6 to 8 weeks is not met.”
b. “Goal that the medication will be effective is not met.”
c. “Goal that the patient will take medications as prescribed is not met.”
d. “Goal that the patient understands the medication regimen is not met.”
ANS: A
All indications are that this patient is taking the medications and they are not effective. The
first statement is correct because it identifies a measurable goal and a specific time frame.
DIF: Cognitive Level: Applying (Application)
Evaluation MSC: NCLEX: Management of Care
TOP: Nursing Process:
15. During a home visit, the nurse learns that a patient has not been taking their medications as
prescribed. The patient reports having no insurance and tells the nurse that the drug is too
expensive. After learning that there is no substitute medication, the nurse will perform which
action next?
a. Assist the patient to apply for a patient-assist program.
b. Contact the pharmacy to request a reduction in the cost of the drug.
c. Determine the patient’s annual income.
d. Give the patient the number of a charitable organization that may be able to help.
ANS: C
Patient-assist programs may be helpful, but many are dependent on the patient’s income, so
the nurse should determine that first. It is unlikely that the pharmacy would offer a cost
reduction. The patient has demonstrated an inability to navigate the system by simply not
taking the medication, so only providing a phone number to the patient is not likely to be
effective.
DIF: Cognitive Level: Applying (Application)
TOP: Nursing Process: Assessment/Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
5 | P a g eChapter 02: Drug Development and Ethical Considerations
MULTIPLE CHOICE
1. The nurse is obtaining consent from a subject newly recruited for a clinical drug trial that will
last for 6 months. All subjects will be given gift certificates for participating. One subject says,
“Well, I guess if the drug doesn’t work, I’ll just have to put up with the symptoms for 6
months.” What will the nurse tell the subject?
a. “Participation for the duration of the study is required.”
b. “Participation may end at any time without penalty.”
c. “Withdrawal from the study may end at any time, but the gift certificate will not be
given.”
d. “You can request placement in the treatment group.”
ANS: B
All participants have the right to autonomy, which is the right to self-determination. Patients
have the right to refuse to participate or to withdraw from a study at any time without
penalty. Patients generally are not allowed to choose participation in either the treatment or
the control group.
DIF: Cognitive Level: Understanding
(Comprehension) TOP: Nursing Process: Nursing
Intervention
MSC: NCLEX: Management of Client Care
2. The nurse is assisting with a clinical drug trial in which the side effects of two effective drugs
are being compared. A patient who would benefit from either drug has elected to withdraw
from the study, and the nurse assists with the paperwork to facilitate this. This is an example
of
a. autonomy.
b. beneficence.
c. justice.
d. veracity.
ANS: A
All participants have the right to autonomy, which is the right to self-determination. Patients
have the right to refuse to participate or to withdraw from a study at any time without
penalty even if the health care provider disagrees with that choice.
DIF: Cognitive Level: Understanding (Comprehension)
N/A MSC: NCLEX: Management of Client Care
TOP: Nursing Process:
3. During a clinical drug trial for a new medication, researchers note a previously unknown
serious adverse effect occurring in more than 50% of subjects. The study is discontinued.
Which ethical principle is being exercised?
a. Beneficence
b. Justice
c. Respect for persons
d. Veracity
ANS: A
Beneficence is the duty to protect subjects from harm. Once a serious adverse effect is noted
and it is determined that the benefits do not outweigh the risks of the study, researchers
6 | P a g ehave an ethical obligation to stop the study.
DIF: Cognitive Level: Understanding (Comprehension)
N/A MSC: NCLEX: Management of Client Care
4. In a 5-year experimental clinical trial to investigate a new cancer treatment, researchers in
the second year note overwhelming improvement in almost all of the subjects in the treatment
group. It is decided to stop the trial early and report the findings due to the overwhelmingly
beneficial effects. This decision was made based on which ethical principle?
a. Beneficence
b. Justice
c. Respect for persons
d. Veracity
ANS: B
The principle of justice requires that all people be treated fairly. Because the findings were
overwhelmingly positive, an ethical decision was made to stop the study early and report
findings so that additional people could gain benefit from the treatment.
DIF: Cognitive Level: Understanding (Comprehension)
N/A MSC: NCLEX: Management of Client Care
TOP: Nursing Process:
5. The nurse is enrolling subjects for a double-blind experimental study. One patient asks the
nurse to explain the role of the experimental group. The nurse will explain that subjects in the
experimental group in this type of study:
a. are selected for participation in that group.
b. have unique baseline characteristics.
c. receive a placebo.
d. receive the experimental treatment being evaluated.
ANS: D
In a double-blind experimental study, subjects in the experimental group receive the treatment
or drug under study. They are randomly assigned and not selected. They should have similar
baseline characteristics to those in the control group. They do not receive a placebo.
DIF: Cognitive Level: Understanding (Comprehension)
TOP: Nursing Process: Nursing Intervention: Patient Teaching
MSC: NCLEX: Management of Client Care
6. The nurse is obtaining signatures on consent forms for participation in a clinical drug trial.
One patient says, “I’m not sure I want to do this, but I need the cash.” The nurse will take
which action?
a. Ask the patient to clarify concerns.
b. Reinforce that cash is given to all subjects equally.
c. Report this statement to the lead investigator.
d. Review the elements of the study and obtain consent.
ANS: C
If a nurse suspects that a patient is being coerced to participate in the study, the nurse
should report this to the principal investigator. When a patient verbalizes participation based
on a financial reward, there is a potential element of coercion.
DIF: Cognitive Level: Applying
(Application) TOP: Nursing Process: Nursing
Intervention MSC: NCLEX: Management of
Client Care
7. Which is the characteristic of preclinical in vivo testing?
7 | P a g e
TOP: Nursing Process:a. A comparison of experimental and control data in animals
b. A study conducted in a test tube in a laboratory
c. A study that determines the effects of the placebo in human participants
d. A study to assess the seriousness of the disease to be treated
ANS: A
Preclinical in vivo testing is performed in animals or other living organisms. In vitro studies
occur in test tubes. Safe therapeutic dose studies are part of clinical research. Prior to clinical
trials, an assessment is made of the disease and its seriousness.
DIF: Cognitive Level: Understanding (Comprehension)
N/A MSC: NCLEX: Management of Client Care
TOP: Nursing Process:
8. Many drugs marketed in the 1980s may not be effective in a majority of the population. The
nurse understands that this is because these drugs:
a. did not pass through the appropriate phases of clinical trials.
b. did not require human subject protections and are invalid.
c. were not tested in women, minorities, or children.
d. were tested on healthy subjects only.
ANS: C
Drug research was historically performed only with Caucasian males, causing uncertainty as
to the validity of the research results in the broader population.
DIF: Cognitive Level: Understanding (Comprehension)
N/A MSC: NCLEX: Management of Client Care
TOP: Nursing Process:
9. The nurse is assisting with data collection in a study of drug effects in as mall group of
healthy subjects. The nurse assists with blood and urine collection to determine serum drug
levels and the presence of metabolites in urine. Which phase of drug development does this
represent?
a. Phase I
b. Phase II
c. Phase III
d. Phase IV
ANS: A
Phase I drug trials are performed to assess safety and to identify the pharmacokinetics, such as
metabolism and elimination, of drugs in healthy subjects.
DIF: Cognitive Level: Understanding (Comprehension)
N/A MSC: NCLEX: Management of Client Care
TOP: Nursing Process:
10. The nurse is enrolling subjects for a clinical drug trial in which subjects will be randomly
assigned to either a treatment or a placebo group. The pills in both groups will be in identical
packaging with identical appearance. The group that receives the intervention is the:
a. control group.
b. experimental group.
c. dependent group.
d. independent group.
ANS: B
The experimental group in a drug trial is the group that receives the drug being tested. The
control group may receive no drug, a different drug, a placebo, or the same drug with a
different dose, route, or frequency of administration. Dependent and independent are not
terms to describe groups in a study; they denote the variables.
DIF: Cognitive Level: Understanding (Comprehension)
8 | P a g e
TOP: Nursing Process:N/A MSC: NCLEX: Management of Client Care
11. Respect for Persons is a core ethical principle of human subjects research. Which of the
following best describes this principle?
a. Duty to protect research subjects from harm.
b. Fair selection of research subjects.
c. Right to self-determination
d. Patients are independent and capable of making decisions in their own
best interests.
ANS: D
Respect for persons is based on the notion that patients should be treated as
independent persons who are capable of making decisions in their own best interests.
DIF: Cognitive Level: Understanding (Comprehension)
TOP: Nursing Process:
N/A MSC: NCLEX: Management of Client Care
12. A clinical drug trial is concluding a study of pharmacokinetics and safety of a drug in healthy
individuals. The nurse will assist enrollment of participants into the next phase of the study
and will include which subjects?
a. Healthy subjects
b. Healthy and ill subjects
c. Subjects with the disease the drug will treat
d. Subjects with other diseases
ANS: C
After Phase I studies demonstrating drug safety and pharmacokinetics have been completed,
the drug is tested on subjects who have the disease the drug will treat.
DIF: Cognitive Level: Understanding
(Comprehension) TOP: Nursing Process: Nursing
Intervention
MSC: NCLEX: Management of Client Care
13. Before marketing a new drug that has been approved for use based on clinical effectiveness
and safety, the manufacturer wishes to study the potential new uses for the drug. This is an
example of which phase of study?
a. Phase I
b. Phase II
c. Phase III
d. Phase IV
ANS: D
Phase IV studies are performed, in part, to examine potential new indications for approved
drugs.
DIF: Cognitive Level: Understanding (Comprehension)
N/A MSC: NCLEX: Management of Client Care
TOP: Nursing Process:
14.
Which statement about the safety and efficacy of medications in children is accurate?
a. Children cannot give consent, so clinical drug trials are not performed on children.
b. Children can only be subjects in quasi-experimental clinical studies.
c. Data from adult clinical drug trials should be extrapolated to children.
d. Federal law requires that drugs for children be tested on children.
ANS: D
The U.S. Food and Drug Administration (FDA) Modernization Act of 1997 requires that
drugs intended for use in children be tested on children.
9 | P a g eDIF: Cognitive Level: Understanding (Comprehension)
N/A MSC: NCLEX: Management of Client Care
TOP: Nursing Process:
15. The nurse is preparing to administer a schedule II injectable drug and is drawing up half of the
contents of a single-use vial. Which nursing action is correct?
a. Ask another nurse to observe and cosign wasting the remaining drug from the vial.
b. Keep the remaining amount in the patient’s drawer to give at the next dose.
c. Record the amount unused in the patient’s medication record.
d. Dispose of the vial with the remaining drug into a locked collection box.
ANS: A
Schedule II drugs are controlled substances, and all must be accounted for. When wasting a
portion of a drug, another nurse should observe and cosign that a drug was wasted.
DIF: Cognitive Level: Applying
(Application) TOP: Nursing Process: Nursing
Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
16. A patient is prescribed a medication and asks the nurse if the drug is available in a generic
form. The nurse understands that a generic drug name is:
a. a registered trademark.
b. always capitalized.
c. related to the drug’s chemical structure.
d. nonproprietary.
ANS: D
The generic name is the official, nonproprietary name for a drug. The brand name is the
trademark name and is always capitalized. The chemical name describes the chemical
structure of the drug.
DIF: Cognitive Level: Understanding (Comprehension)
TOP: Nursing Process: N/A
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
17. A patient receives a prescription on which the provider has noted that a generic medication
may be given. The patient asks the nurse what this means. What will the nurse tell the patient
about generic drugs?
a. They contain the same inert ingredients as brand-name drugs.
b. They have chemical structures that are different from proprietary drugs.
c. They tend to be less expensive than brand-name drugs.
d. They undergo extensive testing before they are marketed.
ANS: C
Generic drugs are approved by the FDA if they are proved to be bioequivalent to the
brand-name drug. They tend to be less expensive because manufacturers of these drugs do
not have to do the extensive testing required of brand-name drugs before marketing. They are
not identical to brand-name drugs and often have different inert ingredients.
DIF: Cognitive Level: Applying (Application)
TOP: Nursing Process: Nursing Intervention: Patient Teaching
MSC: NCLEX: Management of Client Care
18. The nurse reviews information about a drug and notes the initials “United States
Pharmacopeia (USP)” after the drug’s official name. The nurse understands that this
designation indicates the drug:
a. is a controlled substance.
b. is approved by the FDA.
10 | P a g ec. is available in generic form.
d. meets USP quality and safety standards.
ANS: D
The “USP” designation is given to drugs that have met high standards for therapeutic use,
patient safety, quality, purity, strength, packaging safety, and dosage form by the United States
Pharmacopoeia National Formulary. The FDA classifies controlled substances with Roman
numerals from I to V. The USP designation does not indicate FDA approval. The USP
designation does not indicate generic availability.
DIF: Cognitive Level: Understanding (Comprehension)
TOP: Nursing Process:
N/A MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
19. The nurse is preparing to give a medication to a child. The medication is approved for use in
children. The child’s parent asks whether the drug is safe for children. How will the nurse
respond to the parent?
a. “Drugs approved for use in children are tested on adults and safe doses for children
are based on weights compared to adult weights.”
b. “Drugs approved for use in children are deemed safe for children over time when
repeated use proves effectiveness and safety.”
c. “Drugs approved for use in children are tested for both efficacy and safety in
children in order to be marketed for pediatric use.”
d. “Drugs approved for use in children are tested on children in post-marketing
studies and on a limited basis.”
ANS: C
The Pediatric Research Equity Act requires drug manufacturers to test drugs on children.
DIF: Cognitive Level: Applying
(Application) TOP: Nursing Process: Nursing
Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
20. Which law(s) govern all drug administration by nurses?
a. Drug Regulation and Reform Act
b. FDA Amendments Act
c. Nurse Practice Acts
d. The Controlled Substances Act
ANS: C
Each state’s Nurse Practice Act identifies how nurses administer medications. The other acts
govern how drugs are marketed and tested.
DIF: Cognitive Level: Understanding (Comprehension)
TOP: Nursing Process:
N/A MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
21. A patient is taking methadone as part of a heroin withdrawal program. The nurse
understands that, in this instance, methadone is classified as which drug schedule?
a. C-I
b. C-II
c. C-III
d. C-V
ANS: B
Methadone is a category II drug, with a high potential for drug abuse.
DIF: Cognitive Level: Understanding (Comprehension)
TOP: Nursing Process:
N/A MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
11 | P a g e22. The nurse is preparing to administer a combination drug containing acetaminophen
and codeine. The nurse knows that this drug is classified as which drug schedule?
a. C-II
b. C-III
c. C-IV
d. C-V
ANS: B
Codeine is normally a category II drug, except when it is part of a combination product such
as with acetaminophen, making it a category III drug.
DIF: Cognitive Level: Understanding (Comprehension)
TOP: Nursing Process:
N/A MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
MULTIPLE RESPONSE
1. Which are responsibilities of the FDA? (Select all that apply.)
a. To ensure a drug has accurate labeling.
b. To ensure a drug is affordable.
c. To ensure a drug is effective.
d. To ensure a drug is free from adverse reactions.
e. To ensure a drug is tested for harmful effects.
ANS: A, C, E
The FDA ensures that drugs are labeled correctly, that they are tested and proven effective for
the conditions they are marketed to treat, and that they are tested for harmful effects. The FDA
does not ensure affordability or freedom from adverse reactions, although these must be noted
in drug information materials.
DIF: Cognitive Level: Understanding (Comprehension)
TOP: Nursing Process:
N/A MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
Chapter 03: Pharmacokinetics, Pharmacodynamics, and Pharmacogenetics
MULTIPLE CHOICE
1. Which drug will go through a disintegration process after it is administered?
a. Intramuscular (IM) cephalosporins
b. Intravenous (IV) vasopressors
12 | P a g ec. Oral analgesics
d. Subcutaneous insulin
ANS: C
When drugs are administered parenterally, there is no disintegration process, which occurs
when a drug becomes a solution that can cross the biologic membrane.
DIF: Cognitive Level: Understanding
(Comprehension) TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
2. The nurse is preparing to administer an oral medication and wants to ensure a rapid
drug action. Which form of the medication will the nurse prefer to administer?
a. Capsule
b. Enteric-coated pill
c. Liquid suspension
d. Tablet
ANS: C
Liquid drugs are already in solution, which is the form necessary for absorption in the
gastrointestinal (GI) tract. The other forms must disintegrate into small particles and then
dissolve before being absorbed.
DIF: Cognitive Level: Understanding
(Comprehension) TOP: Nursing Process: Nursing
Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
3. The nurse is teaching a patient who will be discharged home with a prescription for an
enteric-coated tablet. Which statement by the patient indicates understanding of the teaching?
a. “I may crush the tablet and put it in applesauce to improve absorption.”
b. “I should consume acidic foods to enhance absorption of this medication.”
c. “I should expect a delay in onset of the drug’s effects after taking the tablet.”
d. “I should take this medication with high-fat foods to improve its action.”
ANS: C
Enteric-coated tablets resist disintegration in the acidic environment of the stomach and
disintegrate when they reach the small intestine. There is usually some delay in onset of
actions after taking these medications. Enteric-coated tablets should not be crushed or
chewed, which would alter the time and location of absorption. Acidic foods will not enhance
the absorption of the medication. The patient should not eat high-fat food before ingesting an
enteric-coated tablet because high-fat foods decrease the absorption rate.
DIF: Cognitive Level: Applying
(Application) TOP: Nursing Process: Nursing
Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
4. A patient who is newly diagnosed with type 1 diabetes mellitus asks why insulin must be
given by subcutaneous injection instead of by mouth. The nurse will explain that this is
because
a. absorption is diminished by the first-pass effects in the liver.
b. absorption is faster when insulin is given subcutaneously.
c. digestive enzymes in the GI tract break down the drug and prevent absorption.
d. the oral form is less predictable with more adverse effects.
ANS: C
Insulin, growth hormones, and other protein-based drugs are destroyed in the GI tract by
13 | P a g edigestive enzymes and must be given parenterally. Because insulin is destroyed by digestive
enzymes, it must be given parenterally and would not make it to the liver for metabolism with
a first-pass effect.
DIF: Cognitive Level: Understanding (Comprehension)
TOP: Nursing Process: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
5. The nurse is preparing to administer an oral medication that is water soluble. The
nurse understands that this drug:
a. must be taken on an empty stomach.
b. requires active transport for absorption.
c. should be taken with fatty foods.
d. will readily diffuse into the GI tract.
ANS: B
Water-soluble drugs require a carrier enzyme or protein to pass through the GI membrane.
DIF: Cognitive Level: Understanding
(Comprehension) TOP: Nursing Process: Nursing
Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
6. The nurse is preparing an injectable drug and wants to administer it for the most
rapid absorption as possible. How will the nurse give this medication?
a. IM into the deltoid muscle
b. IM into the gluteal muscle
c. Subcut into abdominal tissue
d. Subcut into the upper arm
ANS: A
Drugs given IM are absorbed faster in muscles that have the highest blood flow, such as the
deltoid, rather than those with fewer blood vessels, such as the gluteals. Subcutaneous
absorption is slower when compared to IM drug administration.
DIF: Cognitive Level: Applying (Application)
TOP: Nursing Process:
Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
7. The nurse is reviewing medication information with a nursing student prior to
administering an oral drug and notes that the drug has extensive first-pass effects. Which
statement by the student indicates an understanding of the first-ass effect?
a. “The first-pass effect means the drug has 100% bioavailability.”
b. “The first-pass effect means the drug is absorbed from the GI tract into the portal
vein where it is transported to the liver and metabolized.”
c. “The first-pass effect means the drug was given by injection and immediately
metabolized.”
d. “The first-pass effect means the drug may be unchanged as it passes through the
liver.”
ANS: B
Drugs that undergo first-pass metabolism are absorbed into the portal vein from the
intestinal lumen and go through the liver, where they are metabolized to an inactive or a more
active form.
DIF: Cognitive Level: Understanding
(Comprehension) TOP: Nursing Process: Nursing
Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
14 | P a g e8. The nurse prepares to change a patient’s medication from an IV to an oral form and notes
that the oral form is ordered in a higher dose. The nurse understands that this is due to
differences in:
a. bioavailability.
b. pinocytosis.
c. protein binding.
d. tachyphylaxis.
ANS: A
Oral drugs may have less bioavailability because a lower percentage of the drug reaches the
systemic circulation. Pinocytosis refers to the process by which cells carry a solute across a
membrane. Protein binding can occur with both routes. Tachyphylaxis describes a rapid
decrease in response to drugs that occurs when tolerance develops quickly.
DIF: Cognitive Level: Understanding
(Comprehension) TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
9. The nurse is preparing to administer a drug and learns that it is 90% protein bound.
The patient’s serum albumin level is low. The nurse will observe the patient for:
a. decreased drug absorption.
b. decreased drug interactions.
c. decreased drug toxicity.
d. increased drug effects.
ANS: D
Drugs that are highly protein-bound bind with albumin and other proteins, leaving less free
drug in circulation. If a patient has a low albumin, less drug is not bound, and there is more
free drug to cause drug effects. There would be a potential for increased interactions with
other drugs and increased toxicity.
DIF: Cognitive Level: Applying (Application)
TOP: Nursing Process: Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
10. The nurse is administering two drugs to a patient and learns that both drugs are
highly protein-bound. The nurse may expect
a. decreased bioavailability of both drugs.
b. decreased drug effects.
c. decreased drug interactions.
d. increased risk of adverse effects.
ANS: D
Two drugs that are highly protein-bound may compete for protein-binding sites, leaving more
free drug in the circulation and an increased risk of adverse effects as well as increased drug
effects, and an increased risk for drug interactions.
DIF: Cognitive Level: Applying (Application)
TOP: Nursing Process:
Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
11. A patient has been taking a drug that is 75% protein-Bound. The provider adds a new
medication that is 90% protein-bound. The nurse will expect a potential:
a. decreased drug effects of the first drug.
b. decreased therapeutic range of the first drug.
c. increased drug effects of the first drug.
d. increased therapeutic range of the first drug.
ANS: C
Adding another highly protein-bound drug will displace the first drug from protein-binding
15 | P a g esites and release more free drug, increasing the drug’s effects. This does not alter the
therapeutic range, which is theserum level between drug effectiveness and toxicity.
DIF: Cognitive Level: Applying (Application)
TOP: Nursing Process: Nursing Intervention/Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
12. The nurse gives a highly metabolized medication to a patient with a history of liver disease.
The nurse will monitor this patient for:
a. decreased drug effects.
b. increased drug effects.
c. decreased therapeutic range.
d. increased therapeutic range.
ANS: B
Liver diseases such as cirrhosis and hepatitis alter drug metabolism by inhibiting the
drug-metabolizing enzymes in the liver. When the drug metabolism rate is decreased, excess
drug accumulation can occur and lead to toxicity.
DIF: Cognitive Level: Applying (Application)
TOP: Nursing Process: Assessment/Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
13. The nurse gives 800 mg of a drug that has a half-life of 8 hours. How much drug will be left
in the body in 24 hours if no additional drug is given?
a. None
b. 50 mg
c. 100 mg
d. 200 mg
ANS: C
Eight hours after the drug is given, there will be 400 mg left. Eight hours after that (16 hours),
there will be 200 mg left. At 24 hours, there will be 100 mg left.
DIF: Cognitive Level: Applying (Application)
TOP: Nursing Process:
Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
14. If a drug has a half-life of 12 hours and is given twice daily starting at 0800 on a Monday,
when will a steady state be achieved?
a. 0800 on Tuesday
b. 0800 on Wednesday
c. 0800 on Thursday
d. 0800 on Friday
ANS: B
Steady-state levels occur in approximately 4 half-lives. Wednesday at 0800 is 4 half-lives
from the original dose (12 hours x 4 = 48 hours).
DIF: Cognitive Level: Applying (Application)
TOP: Nursing Process:
Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
15. The nurse is preparing to administer a drug that is ordered to be given twice daily. The
nurse reviews the medication information and learns that the drug has a half-life of 24 hours.
What
will the nurse do next?
a. Administer the medication as ordered
b. Contact the provider to discuss daily dosing
c. Discuss every-other-day dosing with the provider
16 | P a g ed. Hold the medication
ANS: B
A drug with a longer half-life should be given at longer intervals to avoid drug toxicity.
DIF: Cognitive Level: Applying (Application)
TOP: Nursing Process:
Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
16. The nurse is caring for a patient who has taken an overdose of aspirin several hours prior.
The provider orders sodium bicarbonate to be given. The nurse understands that this drug is
given for which purpose?
a. To counter the toxic effects of the aspirin
b. To decrease the half-life of the aspirin
c. To increase the excretion of the aspirin
d. To neutralize the acid of the aspirin
ANS: C
Aspirin is a weak acid and is more readily excreted in alkaline urine. Sodium bicarbonate
alkalizes the urine. It does not act as an antidote to aspirin, decrease the half-life, or neutralize
its pH.
DIF: Cognitive Level: Applying (Application)
TOP: Nursing Process:
Planning MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
17. The nurse is preparing to administer a drug that is eliminated through the kidneys. The nurse
reviews the patient’s chart and notes that the patient has increased serum creatinine and
blood urea nitrogen (BUN). The nurse will perform which action?
a. Administer the drug as ordered.
b. Anticipate a shorter than usual half-life of the drug.
c. Expect decreased drug effects when the drug is given.
d. Verify that the dose ordered is appropriate based on the patient’s kidney function.
ANS: D
Increased creatinine and BUN indicate decreased renal function, so a drug that is eliminated
through the kidneys can become toxic. The nurse should verify that the ordered dose is
appropriate based on the patient’s kidney function, and if not, discuss a lower dose with the
provider. The drug will have a longer half-life and will exhibit increased effects with
decreased renal function.
DIF: Cognitive Level: Applying
(Application) TOP: Nursing Process: Nursing
Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
18. The nurse understands that the length of time needed for a drug to reach the
minimum effective concentration (MEC) is the
a. duration of action.
b. onset of action.
c. peak action time.
d. time response curve.
ANS: B
The onset of action is the time it takes to reach the MEC. Duration of action is the length of
time a drug has a pharmacologic effect. Peak action time occurs when the drug reaches its
highest blood level. The time response curve is an evaluation of the other three measures.
DIF: Cognitive Level: Remembering (Knowledge)
TOP: Nursing Process:
N/A MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
17 | P a g e19. The nurse administers albuterol to a patient who has asthma. The albuterol acts by
stimulating beta2-adrenergic receptors to cause bronchodilation. The nurse understands that
albuterol is a beta-adrenergic:
a. agonist.
b. antagonist.
c. inhibitor.
d. depressant.
ANS: A
An agonist medication is one that stimulates a certain type of receptor to produce a
therapeutic response.
DIF: Cognitive Level: Understanding (Comprehension)
TOP: Nursing Process:
N/A MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
20. The nurse is preparing to administer the first dose of digoxin (Lanoxin) to a patient and
notes that the initial dose ordered is much higher than the ordered maintenance dose. Which
of the following describes why the first dose is higher?
a. Digoxin requires a loading dose.
b. Digoxin undergoes first-pass metabolism when initially administered.
c. Digoxin has a long duration of action.
d. Digoxin has a short half-life.
ANS: A
The reason the first dose is higher than the ordered maintenance dose is because a loading
dose is required. This is performed to more quickly reach steady state for a drug with a long
half-life. The loading is not given due to first-pass metabolism or duration of action.
DIF: Cognitive Level: Applying
(Application) TOP: Nursing Process: Nursing
Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
21. The nurse administers a centrally acting analgesic to a patient who has been receiving it for 1
day after orthopedic surgery with successful pain relief. The patient reports no change in pain
30 minutes after the medication is given. The nurse recognizes that this patient is likely
exhibiting:
a. drug-seeking behavior.
b. drug tolerance.
c. the placebo effect.
d. tachyphylaxis.
ANS: D
Tachyphylaxis is a rapid decrease in response, or acute tolerance. Tolerance to drug effects
can occur with centrally acting analgesics, requiring increased doses in order to achieve
adequate drug effects. Nurses often mistake drug-seeking behavior for drug tolerance. The
placebo effect occurs when the patient experiences a response with an inactive drug.
DIF: Cognitive Level: Understanding
(Comprehension) TOP: Nursing Process: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
22. A patient has been taking a drug for several years and tells the nurse it is no longer working.
The nurse learns that the patient has recently begun taking an over-the-counter (OTC) antacid
medication. What does the nurse suspect is occurring?
a. An adverse drug reaction
b. A drug interaction
c. Drug incompatibility
18 | P a g ed. Drug tolerance
ANS: B
Drug interactions are an altered or modified action or effect of a drug as a result of interaction
with one or more other drugs. An adverse drug reaction can occur with one or more drugs. It
is possible in this scenario that the antacid is preventing adequate absorption of the other
medication. Drug incompatibility is a chemical reaction of two or more drugs that occurs in
vitro. Drug tolerance is the development of reduced response to a medication over time.
DIF: Cognitive Level: Applying (Application)
TOP: Nursing Process: Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
23. The nurse is preparing to administer two IV medications that should not be given using the
same IV tubing. The nurse understands that this is because of drug:
a. adverse reactions.
b. incompatibility.
c. interactions.
d. potentiation.
ANS: B
Drugs that are incompatible cannot be mixed together in solution and cannot be mixed in a
syringe, IV bag, or other artificial environment. Adverse reactions are symptoms occurring
from drug effects. Drug interactions occur in vivo. Potentiation is when one drug causes an
enhanced response to another drug.
DIF: Cognitive Level: Applying
(Application) TOP: Nursing Process: Nursing
Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
24. The nurse is teaching a patient who will begin taking ciprofloxacin. What instruction will the
nurse include when teaching this patient about this drug?
a. “Do not take this medication with oral contraceptive pills.”
b. “Take at least 1 hour after or 2 hours before taking antacids.”
c. “Take in the morning with your multivitamin tablet.”
d. “Take with milk to reduce gastric upset.”
ANS: B
Dairy products, multivitamins,and antacids should be avoided 1 hour after and 2 hours before
taking ciprofloxacin because these products contain divalent cations that form a drug complex
that prevents absorption of the ciprofloxacin.
DIF: Cognitive Level: Applying (Application)
TOP: Nursing Process: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
25. A patient who takes a drug that undergoes gastric absorption will begin taking an opioid
analgesic after sustaining an injury in a motor vehicle accident. The nurse will observe the
patient closely for which effects?
a. Decreased effects of the first drug
b. Increased effects of the first drug
c. Decreased effects of the narcotic
d. Increased effects of the narcotic
ANS: B
Opioids slow gastric emptying, allowing more time for drugs to be absorbed in the stomach.
The nurse should expect a potential for increased effects of the first drug.
19 | P a g eDIF: Cognitive Level: Applying (Application)
TOP: Nursing Process:
Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
26. The nurse is preparing to administer furosemide to a patient who takes digoxin. The nurse will
plan to monitor the patient for:
a. digoxin toxicity.
b. decreased digoxin effects.
c. furosemide toxicity.
d. decreased furosemide effects.
ANS: A
The renal loss of potassium can result in hypokalemia, which can enhance the action of
digoxin and can lead to toxicity.
DIF: Cognitive Level: Applying (Application)
TOP: Nursing Process:
Evaluation MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
27. A young adult female patient who takes a combination oral contraceptive (OCP) will begin
taking an antibiotic. When teaching the patient about this medication, the nurse will while
taking the antibiotic:
a. recommend using a backup method of contraception.
b. suggest that she switch to an injectable form of contraception.
c. tell her that the antibiotic is less effective if she is taking OCPs.
d. tell her the antibiotic has a greater risk for toxicity while taking OCPs.
ANS: A
Gut bacteria are necessary to hydrolyze estrogen conjugates into free estrogens. Concurrent
antibiotic administration can decrease the effectiveness of OCPs. A [Show Less]