Details of TEST BANK LEHNES PHARMACOLOGY FOR NURSING CARE 10TH EDITION BURCHUMContents
Chapter 1: Orientation to Pharmacology
... [Show More] ................................ ................................ .... 4 Chapter 2: Application of Pharmacology in Nursing Practice ................................ ................... 5 Chapter 3: Drug Regulation, Development, Names, and Information ................................ ........... 10 Chapter 4: Pharmacokinetics ................................ ................................ ............ 12 Chapter 5: Pharmacodynamics ................................ ................................ ........... 16 Chapter 6: Drug Interactions ................................ ................................ ............ 19 Chapter 7: Adverse Drug Reactions and Medication Errors ................................ ................... 23 Chapter 8: Individual Variation in Drug Responses ................................ .......................... 28 Chapter 9: Drug Therapy During Pregnancy and Breast-Feeding ................................ .............. 31 Chapter 10: Drug Therapy in Pediatric Patients ................................ ............................ 35 Chapter 11: Drug Therapy in Geriatric Patients ................................ ............................. 38 Chapter 12: Basic Principles of Neuropharmacology ................................ ......................... 43 Chapter 13: Physiology of the Peripheral Nervous System ................................ .................... 46 Chapter 14: Muscarinic Agonists and Antagonists ................................ ........................... 49 Chapter 15: Cholinesterase Inhibitors and Their Use in Myasthenia Gravis ................................ ...... 52
Chapter 16: Drugs That Block Nicotinic Cholinergic Transmission: Neuromuscular Blocking Agents and Ganglionic Blocking Agents ................................ ................................ ....................... 55 Chapter 17: Adrenergic Agonists ................................ ................................ ......... 59 Chapter 18: Adrenergic Antagonists ................................ ................................ ...... 64 Chapter 19: Indirect-Acting Antiadrenergic Agents ................................ .......................... 69 Chapter 20: Introduction to Central Nervous System Pharmacology ................................ ........... 73 Chapter 21: Drugs for Parkinson’s Disease ................................ ................................ 75 Chapter 22: Alzheimer’s Disease ................................ ................................ ......... 80 Chapter 23: Drugs for Multiple Sclerosis ................................ ................................ .. 84 Chapter 24: Drugs for Epilepsy ................................ ................................ .......... 88 Chapter 25: Drugs for Muscle Spasm and Spasticity ................................ ......................... 94 Chapter 26: Local Anesthetics ................................ ................................ ........... 97 Chapter 27: General Anesthetics ................................ ................................ ....... 101 Chapter 28: Opioid (Narcotic) Analgesics, Opioid Antagonists, and Nonopioid Centrally Acting Analgesics .......... 105 Chapter 29: Pain Management in Patients with Cancer ................................ .................... 111 Chapter 30: Drugs for Headache ................................ ................................ ....... 117 Chapter 31: Antipsychotic Agents and Their Use in Schizophrenia ................................ ........... 120 Chapter 32: Antidepressants ................................ ................................ .......... 126 Chapter 33: Drugs for Bipolar Disorder ................................ ................................ . 132 Chapter 34: Sedative-Hypnotic Drugs ................................ ................................ ... 136 Chapter 35: Management of Anxiety Disorders ................................ ........................... 142 Chapter 36: Central Nervous System Stimulants and Attention-Deficit/Hyperactivity Disorder ................... 144
1 | P a g eChapter 37: Drug Abuse I: Basic Considerations ................................ .......................... 149
Chapter 38: Drug Abuse II: Alcohol ................................ ................................ ..... 151
Chapter 39: Drug Abuse III: Nicotine and Smoking ................................ ........................ 158
Chapter 40: Drug Abuse IV: Major Drugs of Abuse Other Than Alcohol and Nicotine ........................... 161
Chapter 41: Diuretics ................................ ................................ ................. 168
Chapter 42: Agents Affecting the Volume and Ion Content of Body Fluids ................................ ..... 171
Chapter 43: Review of Hemodynamics ................................ ................................ .. 176
Chapter 44: Drugs Acting on the Renin-Angiotensin-Aldosterone System ................................ ..... 179
Chapter 45: Calcium Channel Blockers ................................ ................................ .. 183
Chapter 46: Vasodilators ................................ ................................ .............. 186
Chapter 47: Drugs for Hypertension ................................ ................................ .... 190
Chapter 48: Drugs for Heart Failure ................................ ................................ .... 196
Chapter 49: Antidysrhythmic Drugs ................................ ................................ .... 203
Chapter 50: Prophylaxis of Coronary Heart Disease: Drugs That Help Normalize Cholesterol and Triglyceride Levels 210
Chapter 51: Drugs for Angina Pectoris ................................ ................................ .. 216
Chapter 52: Anticoagulant, Antiplatelet, and Thrombolytic Drugs ................................ ........... 222
Chapter 53: Management of ST-Elevation Myocardial Infarction ................................ ............. 228
Chapter 54: Drugs for Hemophilia ................................ ................................ ...... 232
Chapter 55: Drugs for Deficiency Anemias ................................ ............................... 236
Chapter 56: Hematopoietic Agents ................................ ................................ ..... 241
Chapter 57: Drugs for Diabetes Mellitus ................................ ................................ . 245
Chapter 58: Drugs for Thyroid Disorders ................................ ................................ 250
Chapter 59: Drugs Related to Hypothalamic and Pituitary Function ................................ .......... 255
Chapter 60: Drugs for Disorders of the Adrenal Cortex ................................ .................... 259
Chapter 61: Estrogens and Progestins: Basic Pharmacology and Noncontraceptive Applications .................. 263
Chapter 62: Birth Control ................................ ................................ ............. 267
Chapter 63: Drug Therapy of Infertility ................................ ................................ . 272
Chapter 64: Drugs That Affect Uterine Function ................................ .......................... 276
Chapter 65: Androgens ................................ ................................ ............... 280
Chapter 66: Drugs for Erectile Dysfunction and Benign Prostatic Hyperplasia ................................ . 284
Chapter 67: Review of the Immune System ................................ .............................. 288
Chapter 68: Childhood Immunization ................................ ................................ ... 291
Chapter 69: Immunosuppressants ................................ ................................ ...... 297
Chapter 70: Antihistamines ................................ ................................ ........... 302
Chapter 71: Cyclooxygenase Inhibitors: Nonsteroidal Anti-inflammatory Drugs and Acetaminophen .............. 307
Chapter 72: Glucocorticoids in Nonendocrine Disorders ................................ ................... 313
Chapter 73: Drug Therapy of Rheumatoid Arthritis ................................ ....................... 318
Chapter 74: Drug Therapy of Gout ................................ ................................ ...... 320
Chapter 75: Drugs Affecting Calcium Levels and Bone Mineralization ................................ ........ 323
2 | P a g eChapter 76: Drugs for Asthma ................................ ................................ ......... 329
Chapter 77: Drugs for Allergic Rhinitis, Cough, and Colds ................................ .................. 335
Chapter 78: Drugs for Peptic Ulcer Disease ................................ .............................. 339
Chapter 79: Laxatives ................................ ................................ ................ 344
Chapter 80: Other Gastrointestinal Drugs ................................ ................................ 348
Chapter 81: Vitamins ................................ ................................ ................. 355
Chapter 82: Drugs for Weight Loss ................................ ................................ ..... 361
Chapter 83: Basic Principles of Antimicrobial Therapy ................................ ..................... 366
Chapter 84: Drugs That Weaken the Bacterial Cell Wall I: Penicillins ................................ ......... 371
Chapter 85: Drugs That Weaken the Bacterial Cell Wall II: Cephalosporins, Carbapenems, Vancomycin, Telavancin,
Aztreonam, Teicoplanin, and Fosfomycin ................................ ................................ 376
Chapter 86: Bacteriostatic Inhibitors of Protein Synthesis: Tetracyclines, Macrolides, and Others ................. 380
Chapter 87: Aminoglycosides: Bactericidal Inhibitors of Protein Synthesis ................................ .... 387
Chapter 88: Sulfonamides and Trimethoprim ................................ ............................ 393
Chapter 89: Drug Therapy of Urinary Tract Infections ................................ ..................... 397
Chapter 90: Antimycobacterial Agents: Drugs for Tuberculosis, Leprosy, and Mycobacterium avium Complex Infection
................................ ................................ ................................ ... 402
Chapter 91: Miscellaneous Antibacterial Drugs: Fluoroquinolones, Metronidazole, Daptomycin, Rifampin, Rifaximin,
Bacitracin, and Polymyxins ................................ ................................ ............ 410
Chapter 92: Antifungal Agents ................................ ................................ ......... 413
Chapter 93: Antiviral Agents I: Drugs for Non-HIV Viral Infections ................................ .......... 420
Chapter 94: Antiviral Agents II: Drugs for HIV Infection and Related Opportunistic Infections .................... 425
Chapter 95: Drug Therapy of Sexually Transmitted Diseases ................................ ............... 430
Chapter 96: Antiseptics and Disinfectants ................................ ............................... 434
Chapter 97: Anthelmintics ................................ ................................ ............ 438
Chapter 98: Antiprotozoal Drugs I: Antimalarial Agents ................................ .................... 441
Chapter 99: Antiprotozoal Drugs II: Miscellaneous Agents ................................ .................. 445
Chapter 100: Ectoparasiticides ................................ ................................ ......... 448
Chapter 101: Basic Principles of Cancer Chemotherapy ................................ .................... 452
Chapter 102: Anticancer Drugs I: Cytotoxic Agents ................................ ........................ 457
Chapter 103: Anticancer Drugs II: Hormonal Agents, Targeted Drugs, and Other Noncytotoxic Anticancer Drugs .... 463
Chapter 104: Drugs for the Eye ................................ ................................ ........ 467
Chapter 105: Drugs for the Skin ................................ ................................ ....... 472
Chapter 106: Drugs for the Ear ................................ ................................ ........ 479
Chapter 107: Miscellaneous Noteworthy Drugs ................................ ........................... 483
Chapter 108: Dietary Supplements ................................ ................................ ..... 487
Chapter 109: Management of Poisoning ................................ ................................ . 490
Chapter 110: Potential Weapons of Biologic, Radiologic, and Chemical Terrorism .............................. 494
3 | P a g eChapter 1: Orientation to Pharmacology
MULTIPLE CHOICE
1. The nurse is teaching a patient how a medication works to treat an illness. To do this, the
nurse will rely on knowledge of:
a. clinical pharmacology.
b. drug efficacy.
c. pharmacokinetics.
d. pharmacotherapeutics.
ANS: D
Pharmacotherapeutics is the study of the use of drugs to diagnose, treat, and prevent
conditions. Clinical pharmacology is concerned with all aspects of drug–human interactions.
Drug efficacy measures the extent to which a given drug causes an intended effect.
Pharmacokinetics is the study of the impact of the body on a drug.
DIF: Cognitive Level: Comprehension REF: Four Basic Terms
TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
2. What does it mean when a drug is described as easy to administer?
a. It can be stored indefinitely without need for refrigeration.
b. It does not interact significantly with other medications.
c. It enhances patient adherence to the drug regimen.
d. It is usually relatively inexpensive to produce.
ANS: C
A major benefit of drugs that are easy to administer is that patients taking them are
more likely to comply with the drug regimen. Drugs that are easy to give may have the
other attributes listed, but those properties are independent of ease of administration.
DIF: Cognitive Level: Comprehension
REF: Additional Properties of an Ideal Drug: Ease of
Administration TOP: Nursing Process: Assessment
MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
3. A patient tells the nurse that he was told by the prescriber that the analgesic he is taking is
very effective. Which statement by the patient demonstrates an understanding of the
drug’s effectiveness?
a. “I don’t have to worry about toxicity, since it takes a large amount of this drug to
cause an overdose.”
b. “It has no side effects and doesn’t interact with other drugs.”
c. “I only have to take it every 12 hours.”
d. “It might make me sleepy, and it lessens pain for several hours at a time.”
ANS: D
A drug is effective if it produces the intended effects, even if it also produces side effects.
Because no drug is completely safe, the level of toxicity does not determine effectiveness. All
drugs have side effects and many react with other substances; these do not affect the drug’s
effectiveness. Ease of administration is independent of a drug’s effectiveness.
DIF: Cognitive Level: Comprehension REF: Properties of an Ideal
4 | P a g eDrug TOP: Nursing Process: Evaluation
MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
MULTIPLE RESPONSE
1. What are the properties of an ideal drug? (Select all that apply.)
a. Irreversible action
b. Predictability
c. Ease of administration
d. Chemical stability
e. A simple trade name
ANS: B, C, D
In addition to predictability, ease of administration, and chemical stability, other properties
include a reversible action so that any harm the drug may cause can be undone and a simple
generic name, because generic names are usually complex and difficult to remember and
pronounce.
DIF: Cognitive Level: Comprehension
REF: Properties of an Ideal Drug | Additional Properties of an Ideal Drug
TOP: Nursing Process: Assessment
MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
2. Before administering a medication, what does the nurse need to know to evaluate how
individual patient variability might affect the patient’s response to the medication? (Select all
that apply.)
a. Chemical stability of the medication
b. Ease of administration
c. Family medical history
d. Patient’s age
e. Patient’s diagnosis
ANS: C, D, E
The family medical history can indicate genetic factors that may affect a patient’s response to a
medication. Patients of different ages can respond differently to medications. The patient’s
illness can affect how drugs are metabolized. The chemical stability of the medication and the
ease of administration are properties of drugs.
DIF: Cognitive Level: Analysis
REF: Sources of Individual
Variation TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential
Chapter 2: Application of Pharmacology in Nursing Practice
MULTIPLE CHOICE
1. A patient is using a metered-dose inhaler containing albuterol for asthma. The medication
label instructs the patient to administer “2 puffs every 4 hours as needed for coughing or
wheezing.” The patient reports feeling jittery sometimes when taking the medication, and she
doesn’t feel that the medication is always effective. Which is not an appropriate nursing
intervention for this patient?
a. Asking the patient to demonstrate use of the inhaler
b. Assessing the patient’s exposure to tobacco smoke
5 | P a g ec. Auscultating lung sounds and obtaining vital signs
d. Suggesting that the patient use one puff to reduce side effects
ANS: D
It is not within the nurse’s scope of practice to change the dose of a medication without an
order from a prescriber. Asking the patient to demonstrate inhaler use helps the nurse to
evaluate the patient’s ability to administer the medication properly and is part of the
nurse’s evaluation. Assessing tobacco smoke exposure helps the nurse determine whether
nondrug therapies, such a smoke avoidance, can be used as an adjunct to drug therapy.
Performing a physical assessment helps the nurse evaluate the patient’s response to the
medication.
DIF: Cognitive Level: Application
REF: Applying the Nursing Process in Drug Therapy: Preadministration Assessment
[and all subsections under this heading] TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
2. A postoperative patient is being discharged home with acetaminophen/hydrocodone (Lortab)
for pain. The patient asks the nurse about using Tylenol for fever. Which statement by the
nurse is correct?
a. “It is not safe to take over-the-counter drugs with prescription medications.”
b. “Taking the two medications together poses a risk of drug toxicity.”
c. “There are no known drug interactions, so this will be safe.”
d. “Tylenol and Lortab are different drugs, so there is no risk of overdose.”
ANS: B
Tylenol is the trade name and acetaminophen is the generic name for the same medication. It
is important to teach patients to be aware of the different names for the same drug to
minimize the risk of overdose. Over-the-counter (OTC) medications and prescription
medications may be taken together unless significant harmful drug interactions are possible.
Even though no drug interactions are at play in this case, both drugs contain acetaminophen,
which could lead to toxicity.
DIF: Cognitive Level: Application
REF: Application of Pharmacology in Patient Education: Dosage and
Administration TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential
3. The nurse is preparing to care for a patient who will be taking an antihypertensive medication.
Which action by the nurse is part of the assessment step of the nursing process?
a. Asking the prescriber for an order to monitor serum drug levels
b. Monitoring the patient for drug interactions after giving the medication
c. Questioning the patient about over-the-counter medications
d. Taking the patient’s blood pressure throughout the course of treatment
ANS: C
The assessment part of the nursing process involves gathering information before beginning
treatment, and this includes asking about other medications the patient may be taking.
Monitoring serum drug levels, watching for drug interactions, and checking vital signs after
giving the medication are all part of the evaluation phase.
DIF: Cognitive Level: Application
REF: Preadministration
Assessment TOP: Nursing Process: Assessment
MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential
6 | P a g e4. A postoperative patient reports pain, which the patient rates as an 8 on a scale from 1 to
10 (10 being the most extreme pain). The prescriber has ordered acetaminophen (Tylenol)
650 mg PO every 6 hours PRN pain. What will the nurse do?
a. Ask the patient what medications have helped with pain in the past.
b. Contact the provider to request a different analgesic medication.
c. Give the pain medication and reposition the patient to promote comfort.
d. Request an order to administer the medication every 4 hours.
ANS: B
The nursing diagnosis for this patient is severe pain. Acetaminophen is given for mild to
moderate pain, so the nurse should ask the prescriber to order a stronger analgesic
medication. Asking the patient to tell the nurse what has helped in the past is a part of an initial
assessment and should be done preoperatively and not when the patient is having severe pain.
Because the patient is having severe pain, acetaminophen combined with nondrug therapies
will not be sufficient. Increasing the frequency of the dose of a medication for mild pain will
not be effective.
DIF: Cognitive Level: Analysis
REF: Analysis and Nursing
Diagnosis TOP: Nursing Process: Diagnosis
MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
5. A patient newly diagnosed with diabetes is to be discharged from the hospital. The nurse
teaching this patient about home management should begin by doing what?
a. Asking the patient to demonstrate how to measure and administer insulin
b. Discussing methods of storing insulin and discarding syringes
c. Giving information about how diet and exercise affect insulin requirements
d. Teaching the patient about the long-term consequences of poor diabetes control
ANS: A
Because insulin must be given correctly to control symptoms and because an overdose can be
fatal, it is most important for the patient to know how to administer it. Asking for a
demonstration of technique is the best way to determine whether the patient has understood
the teaching. When a patient is receiving a lot of new information, the information presented
first is the most likely to be remembered. The other teaching points are important as well, but
they are not as critical and can be taught later.
DIF: Cognitive Level: Application
REF: Planning
TOP: Nursing Process:
Planning MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk
Potential
6. The nurse receives an order to give morphine 5 mg IV every 2 hours PRN pain. Which action is
not part of the six rights of drug administration?
a. Assessing the patient’s pain level 15 to 30 minutes after giving the medication
b. Checking the medication administration record to see when the last dose was
administered
c. Consulting a drug manual to determine whether the amount the prescriber
ordered is appropriate
d. Documenting the reason the medication was given in the patient’s electronic
medical record
ANS: A
Assessing the patient’s pain after administering the medication is an important part of the
nursing process when giving medications, but it is not part of the six rights of drug
administration. Checking to see when the last dose was given helps ensure that the medication
7 | P a g eis given at the right time. Consulting a drug manual helps ensure that the medication is given
in the right dose. Documenting the reason for a pain medication is an important part of the
right documentation—the sixth right.
DIF: Cognitive Level: Application
REF: Evolution of Nursing Responsibilities Regarding Drugs |
Implementation TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential
7. A patient tells a nurse that a medication prescribed for recurrent migraine headaches is
not working. What will the nurse do?
a. Ask the patient about the number and frequency of tablets taken.
b. Assess the patient’s headache pain on a scale from 1 to 10.
c. Report the patient’s complaint to the prescriber.
d. Suggest biofeedback as an adjunct to drug therapy.
ANS: A
When evaluating the effectiveness of a drug, it is important to determine whether the patient is
using the drug as ordered. Asking the patient to tell the nurse how many tablets are taken and
how often helps the nurse determine compliance. Assessing current pain does not yield
information about how well the medication is working unless the patient is currently taking it.
The nurse should gather as much information about compliance, symptoms, and drug
effectiveness as possible before contacting the prescriber. Biofeedback may be an effective
adjunct to treatment, but it should not be recommended without complete information about
drug effectiveness.
DIF: Cognitive Level: Application
REF: Evaluation TOP: Nursing Process: Evaluation
MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
8. A nurse is preparing to administer medications. Which patient would the nurse consider to
have the greatest predisposition to an adverse reaction?
a. A 30-year-old man with kidney disease
b. A 75-year-old woman with cystitis
c. A 50-year-old man with an upper respiratory tract infection
d. A 9-year-old boy with an ear infection
ANS: A
The individual with impaired kidney function would be at risk of having the drug accumulate
to a toxic level because of potential excretion difficulties. Cystitis is an infection of the bladder
and not usually the cause of excretion problems that might lead to an adverse reaction from a
medication. A respiratory tract infection would not predispose a patient to an adverse
reaction, because drugs are not metabolized or excreted by the lungs. A 9-year-old boy would
not have the greatest predisposition to an adverse reaction simply because he is a child; nor
does an ear infection put him at greater risk.
DIF: Cognitive Level: Analysis
REF: Minimizing Adverse Reactions
TOP: Nursing Process: Planning
MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential
9. A nurse consults a drug manual before giving a medication to an 80-year-old patient. The
manual states that elderly patients are at increased risk for hepatic side effects. Which action
by the nurse is correct?
a. Contact the provider to discuss an order for pretreatment laboratory work.
b. Ensure that the drug is given in the correct dose at the correct time to minimize
8 | P a g ethe risk of adverse effects.
c. Notify the provider that this drug is contraindicated for this patient.
d. Request an order to give the medication intravenously so that the drug does
not pass through the liver.
ANS: A
The drug manual indicates that this drug should be given with caution to elderly patients.
Getting information about liver function before giving the drug establishes baseline data that
can be compared with post-treatment data to determine whether the drug is affecting the
liver. Giving the correct dose at the correct interval helps to minimize risk, but without
baseline information, the effects cannot be determined. The drug is not contraindicated.
DIF: Cognitive Level: Analysis
REF: Minimizing Adverse
Effects TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential
10. A patient has been receiving intravenous penicillin for pneumonia for several days and begins
to complain of generalized itching. The nurse auscultates bilateral wheezing and notes a
temperature of 38.5° C (101° F). Which is the correct action by the nurse?
a. Administer the next dose and continue to evaluate the patient’s symptoms.
b. Ask the prescriber if an antihistamine can be given to relieve the itching.
c. Contact the prescriber to request an order for a chest radiograph.
d. Hold the next dose and notify the prescriber of the symptoms.
ANS: D
Pruritus and wheezing are signs of a possible allergic reaction, which can be fatal; therefore,
the medication should not be given and the prescriber should be notified. When patients are
having a potentially serious reaction to a medication, the nurse should not continue giving the
medication. Antihistamines may help the symptoms of an allergic reaction, but the first
priority is to stop the medication. Obtaining a chest radiograph is not helpful.
DIF: Cognitive Level: Application
REF: Evolution of Nursing Responsibilities Regarding Drugs | Application of Pharmacology in
Patient Care: Identifying High-Risk Patients
TOP: Nursing Process:
Evaluation MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk
Potential
MULTIPLE RESPONSE
1. A nurse is reviewing a patient’s medical record before administering a medication. Which
factor(s) can alter the patient’s physiologic response to the drug? (Select all that apply.)
a. Ability to swallow pills
b. Age
c. Genetic factors
d. Gender
e. Height
ANS: B, C, D
Age, genetic factors, and gender all influence an individual patient’s ability to absorb,
metabolize, and excrete drugs; therefore, these factors must be assessed before a medication is
administered. A patient’s ability to swallow pills, although it may determine the way a drug is
administered, does not affect the physiologic response. Height does not affect response; weight
and the distribution of adipose tissue can affect the distribution of drugs.
9 | P a g eDIF: Cognitive Level: Analysis
REF: Evolution of Nursing Responsibilities Regarding Drugs | Application of Pharmacology in
Patient Care: Preadministration Assessment
TOP: Nursing Process: Assessment
MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential
Chapter 3: Drug Regulation, Development, Names, and Information
MULTIPLE CHOICE
1. A nurse educator is conducting a continuing education class on pharmacology. To evaluate the
learning of the nurses in the class, the nurse educator asks, “Which drug name is a generic
drug name?” Which is the correct response?
a. Acetaminophen
b. Tylenol
c. Cipro
d. Motrin
ANS: A
Acetaminophen is the generic name. Tylenol, Cipro, and Motrin are all trade names.
DIF: Cognitive Level: Comprehension REF: Table 3-3: The Three Types of Drug
Names TOP: Nursing Process: Diagnosis
MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
2. The FDA Amendments Act (FDAAA) was passed in 2007 to address which aspect of drug
safety?
a. Allowing pharmaceutical companies to identify off-label uses of medications
approved for other uses
b. Evaluating drug safety information that emerges after a drug has been approved
and is in use
c. Expediting the approval process of the U.S. Food and Drug Administration (FDA) so
that needed drugs can get to market more quickly
d. Requiring manufacturers to notify patients before removing a drug from the market
ANS: B
The FDAAA was passed to enable the Food and Drug Administration to continue oversight of a
drug after granting it approval so that changes in labeling could be made as necessary and
postmarketing risks could be tracked and identified. A provision of the FDA Modernization Act
(FDAMA), passed in 1997, allows drug companies to promote their products for off-label uses
as long as they promise to conduct studies to support their claims. Regulations to permit
accelerated approval of drugs for life-threatening diseases were adopted in 1992 by the FDA.
The requirement that drug companies notify patients 6 months before removing a drug from
the market is a provision of the FDAMA.
DIF: Cognitive Level: Comprehension REF: Landmark Drug
Legislation TOP: Nursing Process: Evaluation
MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
3. A nursing student asks a nurse about pharmaceutical research and wants to know the
purpose of randomization in drug trials. The nurse explains that randomization is used to:
a. ensure that differences in outcomes are the result of treatment and not
differences in subjects.
b. compare the outcome caused by the treatment to the outcome caused by
10 | P a g eno treatment.
c. make sure that researchers are unaware of which subjects are in which group.
d. prevent subjects from knowing which group they are in and prevent preconception
bias.
ANS: A
Randomization helps prevent allocation bias, which can occur when researchers place subjects
with desired characteristics in the study group and other subjects in the control group so that
differences in outcome are actually the result of differences in subjects and not treatment.
Comparing treatment outcome to no treatment outcome is the definition of a controlled study.
The last two options describe the use of blinding in studies; blinding ensures that researchers
or subjects (or both) are unaware of which subjects are in which group so that
preconceptions about benefits and risks cannot bias the results.
DIF: Cognitive Level: Comprehension REF: The Randomized Drug
Trial TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
4. Someone asks a nurse about a new drug that is in preclinical testing and wants to know why it
cannot be used to treat a friend’s illness. Which statement by the nurse is correct?
a. “A drug at this stage of development can be used only in patients with serious
disease.”
b. “At this stage of drug development, the safety and usefulness of the medication is
unknown.”
c. “Clinical trials must be completed to make sure the drug is safe to use in humans.”
d. “Until postmarketing surveillance data are available, the drug cannot be used.”
ANS: B
Preclinical testing must be completed before drugs can be tested in humans. In this stage,
drugs are evaluated for toxicities, pharmacokinetic properties, and potentially useful effects.
Some drugs can be used in patients before completion of Phase III studies, but this is after
preclinical testing is complete. Clinical trials proceed in stages, and each stage has guidelines
defining how a new drug may be used and which patients may receive it. Postmarketing
surveillance takes place after a drug is in general use.
DIF: Cognitive Level: Comprehension
REF: Landmark Drug Legislation | Stages of Drug Development
TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential
5. A patient asks a nurse why drugs that have been approved by the FDA still have unknown
side effects. The nurse tell the patient that:
a. testing for all side effects of a medication would be prohibitively expensive.
b. patients in drug trials often are biased by their preconceptions of a drug’s benefits.
c. researchers tend to conduct studies that will prove the benefits of their new drugs.
d. subjects in drug trials do not always represent the full spectrum of
possible patients.
ANS: D
All drug trials are limited by a relatively small group of subjects who may not have all the
characteristics of people who will be using the drug; therefore, some side effects go
undetected until the drug is in use. Although drug trials are very expensive, this is only an
indirect reason they do not detect all side effects before approval. In theory, well-designed
drug trials, using blinded studies, minimize or eliminate subject bias. Designing studies to
11 | P a g eprove desired results is unethical.
DIF: Cognitive Level: Analysis
REF: Failure to Detect All Adverse
Effects TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
6. A nurse is teaching nursing students about the use of nonproprietary names for drugs.
The nurse tells them which fact about nonproprietary names?
a. They are approved by the FDA and are easy to remember.
b. They are assigned by the U.S. Adopted Names Council.
c. They clearly identify the drug’s pharmacological classification.
d. They imply the efficacy of the drug and are less complex.
ANS: B
Nonproprietary, or generic, names are assigned by the U.S. Adopted Names Council, which
ensures that each drug has only one name. Trade names, or brand names, are approved by
the FDA and are easier to remember. Some nonproprietary names contain syllables that
identify the classification, although not all do. Drug names are not supposed to identify the
use for the drug, although some brand names do so.
DIF: Cognitive Level: Comprehension REF: Drug Names: The Three Types of Drug
Names TOP: Nursing Process: Diagnosis
MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential
Chapter 4: Pharmacokinetics
MULTIPLE CHOICE
1. A patient tells the nurse that the oral drug that has been prescribed has caused a lot of
stomach discomfort in the past. What will the nurse ask the prescriber?
a. Whether a sublingual form of the medication can be given
b. Whether the medication can be given by a parenteral route instead
c. To order an enteric-coated form of the drug
d. Whether the patient can receive a sustained-release preparation of the drug
ANS: C
Enteric-coated drugs are preparations that have been coated with a material that dissolves in
the intestines, not the stomach. This coating is used either to protect the drug from stomach
acid and pepsin or to protect the stomach from a drug that can cause gastric upset. Sublingual
forms often are used for drugs that undergo rapid inactivation during the first pass through
the hepatic circulation so that the drug can be absorbed directly into the systemic circulation.
Parenteral routes are more costly and less safe than oral administration and should not be
used unless necessary. A sustained-release preparation is used to release the drug into the
body over a specific period to reduce the number of daily doses required to sustain
therapeutic drug levels.
DIF: Cognitive Level: Application
REF: Comparing Oral Administration with Parenteral Administration
TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
2. A patient claims to get better effects with a tablet of Brand X of a drug than with a tablet of
Brand Y of the same drug. Both brands contain the same amount of the active ingredient.
What does the nurse know to be most likely?
12 | P a g ea. Advertising by pharmaceutical companies can enhance patient expectations of one
brand over another, leading to a placebo effect.
b. Because the drug preparations are chemically equivalent, the effects of the two
brands must be identical.
c. Tablets can differ in composition and can have differing rates of disintegration and
dissolution, which can alter the drug’s effects in the body.
d. The bioavailability of a drug is determined by the amount of the drug in each dose.
ANS: C
Even if two brands of a drug are chemically equivalent (i.e., they have identical amounts of
the same chemical compound), they can have different effects in the body if they differ in
bioavailability. Tablets made by different manufacturers contain different binders and fillers,
which disintegrate and dissolve at different rates and affect the bioavailability of the drug.
Two brands may be chemically equivalent and still differ in bioavailability, which is not
determined by the amount of drug in the dose.
DIF: Cognitive Level: Application
REF: Pharmaceutical Preparations for Oral Administration TOP: Nursing Process: Diagnosis
MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral
Therapies
3. A patient receives a drug that has a narrow therapeutic range. The nurse administering
this medication will expect to do what?
a. Administer the drug at intervals longer than the drug half-life.
b. Administer this medication intravenously.
c. Monitor plasma drug levels.
d. Teach the patient that maximum drug effects will occur within a short period.
ANS: C
A drug with a narrow therapeutic range is more difficult to administer safely, because the
difference between the minimum effective concentration and the toxic concentration is small.
Patients taking these medications must have their plasma drug levels monitored closely to
ensure that they are getting an effective dose that is not toxic. Administering medications at
longer intervals only increases the time required to reach effective plasma drug levels. Drugs
that have a narrow therapeutic range may be given by any route and do not differ from other
medications in the amount of time it takes to take effect, which is a function of a drug’s
half-life and dosing frequency.
DIF: Cognitive Level: Application
REF: Drug Half-Life
TOP: Nursing Process: Evaluation
MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential
4. A patient is given a prescription for azithromycin (Zithromax) and asks the nurse why the
dose on the first day is twice the amount of the dose on the next 4 days. Which reply by the
nurse is correct?
a. “A large initial dose helps to get the drug to optimal levels in the body faster.”
b. “The first dose is larger to minimize the first pass effect of the liver.”
c. “The four smaller doses help the body taper the amount of drug more gradually.”
d. “Tubular reabsorption is faster with initial doses, so more is needed at first.”
ANS: A
A large initial dose is often used as a loading dose to help get serum drug levels to plateau
levels more quickly. Larger doses do not prevent first pass effects in drugs susceptible to this
type of metabolism. Tapering of doses sometimes is used to prevent rebound or withdrawal
effects and is done by stepping down the amount of drug with each dose. Tubular reabsorption
13 | P a g eis a process that allows drugs to be reabsorbed from the urine into the blood.
DIF: Cognitive Level: Application
REF: Drug Half-Life | Loading Doses versus Maintenance Doses
TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
5. A nurse is giving an enteral medication. The patient asks why this method is preferable for
this drug. How will the nurse reply?
a. “This route allows more rapid absorption of the drug.”
b. “This route is safer, less expensive, and more convenient.”
c. “This route is the best way to control serum drug levels.”
d. “This route prevents inactivation of the drug by digestive enzymes.”
ANS: B
Parenteral routes include the intravenous, intramuscular, and subcutaneous routes. Enteral
routes include oral administration, including pills and liquid suspensions. Enteral routes are
safer, cheaper, and easier to use. Parenteral routes are used when rapid absorption, precise
control of plasma drug levels, and prevention of digestive inactivation are important.
DIF: Cognitive Level: Comprehension
REF: Comparing Oral Administration with Parenteral Administration
TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
6. The nurse is preparing to administer penicillin G intramuscularly to a child. The child’s
parents ask why the drug cannot be given in an oral liquid form. What is the nurse’s reply?
a. “This drug causes severe gastric upset if given orally.”
b. “This drug has a narrow therapeutic range, and the dose must be
tightly controlled.”
c. “This drug is absorbed much too quickly in an oral form.”
d. “This drug would be inactivated by enzymes in the stomach.”
ANS: D
Penicillin G is inactivated by digestive enzymes in the stomach and cannot be given orally. It
does not have a narrow therapeutic range.
DIF: Cognitive Level: Application
REF: Characteristics of Commonly Used Routes of Administration: Intramuscular and
Oral TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
7. A prescriber has written an order for a medication: drug X 100 mg PO every 6 hours. The
half-life for the drug is approximately 6 hours. The nurse is preparing to administer the first
dose at 8:00 AM on Tuesday. On Wednesday, when will the serum drug level reach plateau?
a. 2:00 AM
b. 8:00 AM
c. 2:00 PM
d. 8:00 PM
ANS: B
It takes four half-lives for a drug to reach plateau. Total body stores reach their peak at the
beginning of the fifth dose of a drug if all doses are equal in amount; in this case, this will be
at 8:00 AM the following day.
14 | P a g eDIF: Cognitive Level: Application REF: Drug Half-Life: Time to
Plateau TOP: Nursing Process: Planning MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
8. An adult male patient is 1 day postoperative from a total hip replacement. On a pain scale of 0 to 10, with 10 being the greatest pain, the patient reports a pain level of 10. Which medication would be most appropriate for the nurse to administer to this patient? a. 60 mg morphine sulfate PO b. 75 mg meperidine (Demerol) intramuscularly [Show Less]