Details of TEST BANK ROSENTHAL LEHNE'S PHARMACOTHERAPEUTICS FOR ADVANCED PRACTICE PROVIDERS 1ST EDITIONTable of Contents
Chapter 1: Prescriptive
... [Show More] Authority ................................ ........................ 3 Chapter 2: Rational Drug Selection and Prescription Writing ................................ . 5 Chapter 3: Promoting Positive Outcomes of Drug Therapy ................................ ... 7 Chapter 4: Pharmacokinetics, Pharmacodynamics, and Drug Interactions ..................... 10 Chapter 5: Adverse Drug Reactions and Medication Errors ................................ .. 15 Chapter 6: Individual Variation in Drug Responses ................................ ........ 20 Chapter 7: Drug Therapy During Pregnancy and Breast-Feeding ............................. 23 Chapter 8: Drug Therapy in Pediatric Patients ................................ ............ 27 Chapter 9: Drug Therapy in Geriatric Patients................................ ............. 31 Chapter 10: Basic Principles of Neuropharmacology ................................ ....... 35 Chapter 11: Physiology of the Peripheral Nervous System ................................ .. 38 Chapter 12: Muscarinic Agonists and Antagonists ................................ ......... 41 Chapter 13: Adrenergic Agonists ................................ ........................ 44 Chapter 14: Adrenergic Antagonists ................................ ..................... 49 Chapter 15: Indirect-Acting Antiadrenergic Agents ................................ ........ 54 Chapter 16: Introduction to Central Nervous System Pharmacology .......................... 58 Chapter 17: Drugs for Parkinson's Disease ................................ ............... 61 Chapter 18: Drugs for Alzheimer's Disease ................................ ............... 64 Chapter 19: Drugs for Epilepsy ................................ ......................... 68 Chapter 20: Drugs for Muscle Spasm and Spasticity ................................ ........ 71 Chapter 21: Local Anesthetics ................................ .......................... 75 Chapter 22: Opioid Analgesics, Opioid Antagonists, and Nonopioid Centrally Acting Analgesics ... 79 Chapter 23: Drugs for Headache ................................ ........................ 84 Chapter 24: Antipsychotic Agents and Their Use in Schizophrenia ........................... 88 Chapter 25: Antidepressants ................................ ........................... 94 Chapter 26: Drugs for Bipolar Disorder ................................ .................. 98 Chapter 27: Sedative-Hypnotic Drugs ................................ ................... 102 Chapter 28: Management of Anxiety Disorders ................................ ........... 105 Chapter 29: Central Nervous System Stimulants and Attention-Deficit/Hyperactivity Disorder . 109 Chapter 30: Drug Abuse I: Basic Considerations ................................ .......... 113 Chapter 31: Drug Abuse II: Alcohol ................................ ..................... 116 Chapter 32: Drug Abuse III: Nicotine and Smoking ................................ ....... 120 Chapter 33: Drug Abuse IV: Major Drugs of Abuse Other Than Alcohol and Nicotine ........... 123 Chapter 34: Review of Hemodynamics ................................ .................. 130 Chapter 35: Diuretics ................................ ................................ 132 Chapter 36: Drugs Acting on the Renin-Angiotensin-Aldosterone System ..................... 136
1 | P a g eChapter 37: Calcium Channel Blockers ................................ .................. 140
Chapter 38: Vasodilators ................................ ............................. 143
Chapter 39: Drugs for Hypertension ................................ .................... 146
Chapter 40: Drugs for Heart Failure ................................ .................... 153
Chapter 41: Antidysrhythmic Drugs ................................ .................... 160
Chapter 42: Prophylaxis of Atherosclerotic Cardiovascular Disease: Drugs That Help Normalize
Cholesterol and Triglyceride Levels ................................ .................... 166
Chapter 43: Drugs for Angina Pectoris ................................ .................. 173
Chapter 44: Anticoagulant, Antiplatelet, and Thrombolytic Drugs ........................... 178
Chapter 45: Drugs for Deficiency Anemias ................................ ............... 185
Chapter 46: Drugs for Diabetes Mellitus ................................ ................ 190
Chapter 47: Drugs for Thyroid Disorders ................................ ................ 195
Chapter 48: Estrogens and Progestins: Basic Pharmacology and Noncontraceptive Applications . 200
Chapter 49: Birth Control ................................ ............................. 203
Chapter 50: Androgens ................................ ............................... 208
Chapter 51: Drugs for Erectile Dysfunction and Benign Prostatic Hyperplasia ................. 211
Chapter 52: Review of the Immune System ................................ .............. 214
Chapter 53: Childhood Immunization ................................ ................... 217
Chapter 54: Antihistamines ................................ ........................... 222
Chapter 55: Cyclooxygenase Inhibitors: Nonsteroidal Anti-inflammatory Drugs and
Acetaminophen ................................ ................................ ..... 226
Chapter 56: Glucocorticoids in Nonendocrine Disorders ................................ ... 231
Chapter 57: Drug Therapy of Rheumatoid Arthritis ................................ ....... 236
Chapter 58: Drug Therapy of Gout ................................ ..................... 239
Chapter 59: Drugs Affecting Calcium Levels and Bone Mineralization ........................ 242
Chapter 60: Drugs for Asthma and Chronic Obstructive Pulmonary Disease ................... 247
Chapter 61: Drugs for Allergic Rhinitis, Cough, and Colds ................................ .. 253
Chapter 62: Drugs for Peptic Ulcer Disease ................................ .............. 258
Chapter 63: Laxatives ................................ ................................ 262
Chapter 64: Other Gastrointestinal Drugs ................................ ............... 267
Chapter 65: Vitamins ................................ ................................ 274
Chapter 66: Drugs for Weight Loss ................................ ..................... 278
Chapter 67: Complementary and Alternative Therapies ................................ .... 282
Chapter 68: Basic Principles of Antimicrobial Therapy ................................ .... 285
Chapter 69: Drugs That Weaken the Bacterial Cell Wall I: Penicillins ........................ 288
Chapter 70: Drugs That Weaken the Bacterial Cell Wall II: Other Drugs ...................... 293
Chapter 71: Bacteriostatic Inhibitors of Protein Synthesis ................................ . 297
Chapter 72: Aminoglycosides: Bactericidal Inhibitors of Protein Synthesis .................... 304
Chapter 73: Sulfonamides and Trimethoprim ................................ ............ 309
2 | P a g eChapter 74: Drug Therapy of Urinary Tract Infections ................................ ..... 313
Chapter 75: Antimycobacterial Agents ................................ .................. 318
Chapter 76: Miscellaneous Antibacterial Drugs ................................ ........... 324
Chapter 77: Antifungal Agents ................................ ......................... 327
Chapter 78: Antiviral Agents I: Drugs for Non-HIV Viral Infections .......................... 334
Chapter 79: Antiviral Agents II: Drugs for HIV Infection and Related Opportunistic Infections ... 339
Chapter 80: Drug Therapy of Sexually Transmitted Diseases ............................... 343
Chapter 81: Anthelmintics, Antiprotozoal Drugs, and Ectoparasiticides....................... 346
Chapter 82: Supportive Care of Patients Receiving Anticancer Drugs ........................ 349
Chapter 83: Drugs for Cancer Pain ................................ ..................... 354
Chapter 84: Drugs for the Eye ................................ ......................... 359
Chapter 85: Drugs for the Skin ................................ ........................ 363
Chapter 86: Drugs for the Ear ................................ ......................... 370
Chapter 87: Agents Affecting the Volume and Ion Content of Body Fluids .................... 374
Chapter 88: Management of ST-Elevation Myocardial Infarction ............................ 378
Chapter 89: Additional Acute Care Drugs ................................ ................ 382
Chapter 1: Prescriptive Authority
Multiple Choice
1. An APRN works in a urology clinic under the supervision of a physician who does not restrict
the types of medications the APRN is allowed to prescribe. State law does not require the
APRN to practice under physician supervision. How would the APRN’s prescriptive authority be
described?
a. Full authority
b. Independent
c. Without limitation
d. Limited authority
ANS: B
The APRN has independent prescriptive authority because the regulating body does not require
that the APRN work under physician supervision. Full prescriptive authority gives the provider
the right to prescribe independently and without limitation. Limited authority places restrictions
on the types of drugs that can be prescribed.DIF: Cognitive Level: ComprehensionREF: p. 1TOP:
Nursing Process: I MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic
and Parenteral Therapies
2. Which factors increase the need for APRNs to have full prescriptive authority?
a. More patients will have access to health care.
b. Enrollment in medical schools is predicted to decrease.
c. Physician’s assistants are being utilized less often.
d. APRN education is more complex than education for physicians.
3 | P a g eANS: A
Implementation of the Affordable Care Act has increased the number of individuals with health
care coverage, and thus the number who have access to health care services. The increase in the
number of patients creates the need for more providers with prescriptive authority. APRNs can fill
this practice gap.DIF: Cognitive Level: ComprehensionREF: p. 2TOP: Nursing Process:
Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and
Parenteral Therapies
3. Which factors could be attributed to limited prescriptive authority for APRNs?
Select all that apply.
a. Inaccessibility of patient care
b. Higher health care costs
c. Higher quality medical treatment
d. Improved collaborative care
e. Enhanced health literacy
ANS: A , B
Limiting prescriptive authority for APRNs can create barriers to quality, affordable, and accessible
patient care. It may also lead to poor collaboration among providers and higher health care costs.
It would not directly impact patient’s health literacy.DIF: Cognitive Level: ComprehensionREF:
p. 2TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic
Integrity: Pharmacologic and Parenteral Therapies
4. Which aspects support the APRN’s provision for full prescriptive authority?
Select all that apply.
a. Clinical education includes prescription of medications and disease processes.
b. Federal regulations support the provision of full authority for APRNs.
c. National examinations provide validation of the APRN’s ability to provide safe care.
d. Licensure ensures compliance with health care and safety standards.
e. Limiting provision can decrease health care affordability.
ANS: A , C , D
APRNs are educated to practice and prescribe independently without supervision. National
examinations validate the ability to provide safe and competent care. Licensure ensures
compliance with standards to promote public health and safety. Limited prescriptive authority
creates numerous barriers to quality, affordable, and accessible patient care.DIF: Cognitive Level:
ComprehensionREF: pp. 1-2TOP: Nursing Process: Implementation MSC: NCLEX Client Needs
Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
5. Which aspects support the APRN’s provision for full prescriptive authority?
Select all that apply.
a. Clinical education includes prescription of medications and disease processes.
b. Federal regulations support the provision of full authority for APRNs.
c. National examinations provide validation of the APRN’s ability to provide safe care.
d. Licensure ensures compliance with health care and safety standards.
4 | P a g eANS: A , C , D
APRNs are educated to practice and prescribe independently without supervision. National
examinations validate the ability to provide safe and competent care. Licensure ensures
compliance with standards to promote public health and safety. Limited prescriptive authority
creates numerous barriers to quality, affordable, and accessible patient care.DIF: Cognitive Level:
ComprehensionREF: pp. 1-2TOP: Nursing Process: Implementation MSC: NCLEX Client Needs
Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
6. A family nurse practitioner practicing in Maine is hired at a practice across state lines in
Virginia. Which aspect of practice may change for the APRN?
a. The APRN will have less prescriptive authority in the new position.
b. The APRN will have more prescriptive authority in the new position.
c. The APRN will have equal prescriptive authority in the new position.
d. The APRN’s authority will depend on federal regulations.
ANS: A
Virginia allows limited prescriptive authority, while Maine gives full authority to certified nurse
practitioners. The federal government does not regulate prescriptive authority.DIF: Cognitive
Level: ComprehensionREF: p. 3TOP: Nursing Process: Implementation MSC: NCLEX Client Needs
Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
Chapter 2: Rational Drug Selection and Prescription Writing
Multiple Choice
7. How can collaboration with a pharmacist improve positive outcomes for patients?
Select all that apply.
a. Pharmacists can suggest foods that will help with the patient’s condition.
b. Pharmacists have additional information on drug interactions.
c. The pharmacist can suggest adequate medication dosing.
d. Pharmacists have firsthand knowledge of the facility formulary.
e. Pharmacy can alter prescriptions when necessary to prevent patient harm.
ANS: B , C , D
Providers should collaborate with pharmacists because they will likely have additional information
on formulary, drug interactions, and suggestions for adequate medication dosing. Dietitians can
make foods recommendations to treat the patient’s condition. The pharmacist can contact the
prescriber about questionable prescriptions, but cannot alter the prescription without notification
of and approval by the provider.DIF: Cognitive Level: ComprehensionREF: p. 9TOP: Nursing
Process: Diagnosis MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk
Potential
8. A patient presents with delirium tremens requiring Ativan administration. The provider of care
is not in the facility. Which action by the nurse is most appropriate?
a. Obtain a telephone order.
b. Contact the on-call hospitalist.
c. Obtain an order from the charge nurse.
d. Wait for a written Ativan order.
5 | P a g eANS: A
In an emergency situation, such as delirium tremens with seizure activity, it is acceptable to
provide a telephone order. Contacting the on-call hospitalist or waiting for a written order would
take more time than available for a patient with high seizure risk. Writing an order is outside the
scope of practice for the charge nurse.DIF: Cognitive Level: ApplicationREF: p. 7TOP: Nursing
Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of
Risk Potential
9. A patient with chronic pain calls the provider’s office to request a refill on their oxycontin.
Which action is most appropriate?
a. Fax an order to the pharmacy.
b. Schedule an appointment with the patient.
c. Verify the patient’s adherence to drug regimen.
d. Determine the patient’s current medication dosage.
ANS: B
Schedule II medications are not eligible for refills, and prescriptions must be handwritten. It is
important to verify the patient’s adherence to the drug regimen and determine the current
dosage of medication; however, this can be accomplished by scheduling an appointment and
evaluating the patient in person.DIF: Cognitive Level: ApplicationREF: p. 8TOP: Nursing Process:
Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk
Potential
10. A patient prescribed amoxicillin for streptococcal pharyngitis reports new onset of a flat, itchy
red rash on the chest and neck. Which action is most important?
a. Provide a different prescription.
b. Discontinue the medication.
c. Prescribe an antihistamine cream.
d. Assess for respiratory compromise.
ANS: B
The priority action is to discontinue the medication to prevent worsening of the patient’s
symptoms. A different prescription would be provided, topical antihistamine may be administered,
and the patient would be assessed for respiratory involvement, but these actions would not
be
performed first.DIF: Cognitive Level: ApplicationREF: p. 6TOP: Nursing Process: Implementation
MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential
11. A patient taking three medications for hypertension is diagnosed with COPD. Which action
should be taken prior to prescribing medications to treat COPD?
a. Obtain baseline laboratory values.
b. Obtain a complete medication history.
c. Assess liver enzyme levels.
d. Determine if patient has insurance coverage.
ANS: B
Prior to adding medications to the treatment regimen, it is essential to assess for any potential drug-
6 | P a g edrug interactions through a complete medical history. Baseline laboratory values are not necessary
for COPD treatment. Liver enzyme levels may give insight into the possibility of altered
metabolism but would not be the first action. The presence of insurance coverage would affect the
patient’s access to treatment but may not affect the type of medication prescribed.DIF: Cognitive
Level: ApplicationREF: p. 6TOP: Nursing Process: Implementation MSC: NCLEX Client Needs
Category: Physiologic Integrity: Reduction of Risk Potential
12. A patient with diabetes reports losing their job and an inability to purchase required
medications. Which action is most appropriate?
a. Provide a 7-day sample pack.
b. Decrease the daily dose by half.
c. Contact a different pharmacy.
d. Prescribe a different medication.
ANS: C
Providing a 7-day sample will address the patient’s immediate need, but will not help with the
patient’s long-term need for medication. Decreasing the daily dose will diminish the effectiveness
of the medication. Selecting a different pharmacy could decrease the cost of the medication, as
costs vary based on the location and the pharmacy dispensing the medication. Prescribing a
different medication would be the last option.DIF: Cognitive Level: ApplicationREF: p. 5TOP:
Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity:
Reduction of Risk Potential
13. A patient recently prescribed hydrocodone calls to report they are unable to fill the prescription.
Which factors could contribute to the inability to fill the prescription?
Select all that apply.
a. DEA number missing from prescription
b. Prescription sent via electronic messenger
c. Dose higher than typically prescribed
d. Prescriber license number not included
e. Patient name and date of birth were handwritten
ANS: A , B , D
In order to fill a hydrocodone prescription, the prescriber name, license number, DEA number,
and contact information must be included. Schedule II medications, such as narcotics, must be
prescribed using written prescriptions. Though the pharmacist may question the high dosing, that
would not prevent filling the prescription. The patient’s name and date of birth must be included
on the prescription, but there are no regulations that the name cannot be handwritten.DIF:
Cognitive Level: ComprehensionREF: pp. 6-8TOP: Nursing Process: Diagnosis MSC: NCLEX Client
Needs Category: Physiologic Integrity: Reduction of Risk Potential
Chapter 3: Promoting Positive Outcomes of Drug Therapy
Multiple Choice
14. A patient reports that a medication prescribed for recurrent migraine headaches is not
working. Which action should be taken first?
7 | P a g ea. 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: ApplicationREF: pp. 15-16TOP: Nursing Process: Evaluation MSC: NCLEX Client
Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
15. A patient is prescribed metronidazole for bacterial vaginosis. Which patient history finding
would be most concerning?
a. Recent yeast infection
b. Family history of cervical cancer
c. Drinks two glasses of wine every night
d. Patient is currently unemployed
ANS: C
Patients taking metronidazole should be educated not to drink alcohol to prevent adverse reactions.
It would be concerning that the patient drinks wine daily. History of a yeast infection may indicate
increased risk for recurrence with administration of an antimicrobial. A family history of cervical
cancer is not related to administration of metronidazole. Unemployment can indicate lack of
insurance coverage, which may limit the patient’s ability to purchase medications, but is not the
most concerning patient finding.DIF: Cognitive Level: ApplicationREF: p. 12TOP: Nursing Process:
Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk
Potential
16. A patient is using a metered-dose inhaler containing albuterol for asthma. The medication label
instructs the patient to administer “two 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 action is most appropriate?
a. Asking the patient to demonstrate use of the inhaler
b. Assessing the patient’s exposure to tobacco smoke
c. Auscultating lung sounds and obtaining vital signs
d. Suggesting that the patient use one puff to reduce side effects
ANS: C
Asking the patient to demonstrate inhaler use helps to evaluate the patient’s ability to administer
the medication properly and is part of the nurse’s evaluation, but is not a priority intervention
based on the patient’s current report. Assessing tobacco smoke exposure helps the nurse
determine whether nondrug therapies, such as smoke avoidance, can be used as an adjunct to
drug therapy, but does not relate to the patient’s current problem. Performing a physical
assessment helps the nurse evaluate the patient’s response to the medication and identify the
presence of other side effects.DIF: Cognitive Level: ApplicationREF: p. 13TOP: Nursing Process:
8 | P a g eImplementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and
Parenteral Therapies
17. A patient newly diagnosed with diabetes is to be discharged from the hospital. Which action
should be taken first during medication education?
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: ApplicationREF: p. 11TOP: Nursing Process: Planning
MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential
18. The drug manual states that older adult patients are at increased risk for hepatic side
effects. Which action is most important when prescribing this medication to an 80-year-old
patient?
a. Obtain pretreatment laboratory work.
b. Ensure that the drug is given in the correct dose at the correct time to minimize the risk
of adverse effects.
c. Discontinue the order; the drug is contraindicated for this patient.
d. 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: AnalysisREF:
p. 12TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic
Integrity: Reduction of Risk Potential
19. A patient recently diagnosed with HIV is prescribed several medications to treat the condition.
Which factors could impact the patient’s adherence to the treatment regimen?
Select all that apply.
a. The patient is uninsured
b. The patient works three part-time jobs
c. The medication regimen includes six different pills
d. Patient has an eighth-grade reading comprehension level
e. Medication regimen requires medication be taken at regular 4-hour intervals.
ANS: A , B , C , E
Lack of insurance coverage can inhibit the patient from purchasing the medications, limiting his
access to treatment. Having three part-time jobs indicates that the patient has a busy schedule,
9 | P a g ewhich contributes to forgetfulness and poor adherence. The more complex the medication regimen,
the more difficult it is to maintain patient adherence. Although a patient with an eighth-grade
reading comprehension level may have difficulty understanding professional medical language,
medication teaching can be adjusted to meet the patient’s learning needs.DIF: Cognitive Level:
ComprehensionREF: pp. 13-14TOP: Nursing Process: Evaluation MSC: NCLEX Client Needs
Category: Physiologic Integrity: Reduction of Risk Potential
20. A patient diagnosed with bipolar disorder is prescribed daily lithium. Which action is most
important to determine if the therapeutic level is maintained?
a. Obtain preadministration blood work.
b. Administer medication at regular intervals.
c. Ensure periodic laboratory testing is completed.
d. Assess the patient for adverse effects.
ANS: C
Therapeutic serum levels are determined through periodic laboratory testing. Preadministration
blood work may be necessary to determine the patient’s physical condition but will not determine
therapeutic levels. Scheduling medication administration at regular intervals will help to ensure
medication is absorbed and metabolized predictably, but will not determine therapeutic blood
levels. Assessing the patient for physical signs of adverse effects does not determine if a
therapeutic level has been obtained.DIF: Cognitive Level: ApplicationREF: p. 12TOP: Nursing
Process: Evaluation MSC: NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk
Potential
Chapter 4: Pharmacokinetics, Pharmacodynamics, and Drug Interactions
Multiple Choice
21. The nurse administers naloxone [Narcan] to a patient who has received a toxic dose of
morphine sulfate. The nurse understands that the naloxone is effective because of which
action?
a. Countering the effects of morphine sulfate by agonist actions
b. Increasing the excretion of morphine sulfate by altering serum pH
c. Preventing activation of opioid receptors through antagonist actions
d. Regulating the sensitivity of opioid receptors by neurochemical alterations
ANS: C
Naloxone acts by blocking the action of opioids at opioid receptors. An opioid agonist would
increase the effects of morphine. Naloxone does not affect serum pH or excretion of opioids.
Naloxone does not alter the sensitivity of opioid receptors.DIF: Cognitive Level: AnalysisREF: p.
31TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic
Integrity: Pharmacologic and Parenteral Therapies
22. A patient is taking drug X and receives a new prescription for drug Y, which is listed as an
inducing agent. The nurse caring for this patient understands that this patient may require
doses of drug .
a. lower; X
b. lower; Y
c. higher; X
10 | P a g ed. higher; Y
ANS: C
An inducing agent stimulates the synthesis of CYP isoenzymes, which may increase the
metabolism of other drugs as much as two- to threefold, thereby lowering the level of those drugs
in the body and requiring higher doses to maintain drug effectiveness.DIF: Cognitive Level:
ApplicationREF: p. 36TOP: Nursing Process: Planning MSC: NCLEX Client Needs Category:
Physiologic Integrity: Pharmacologic and Parenteral Therapies
23. 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: ApplicationREF: p. 20TOP: Nursing
Process: Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic
and Parenteral Therapies
24. Which statement about food and drug interactions is true?
a. Foods alter drug absorption and metabolism but not drug action.
b. Medications are best absorbed on an empty stomach.
c. Patient discomfort is the food and drug interaction of most concern.
d. Some foods can inhibit CYP isoenzymes and alter drug metabolism.
ANS: D
Grapefruit juice inhibits CYP3A4, which lowers the metabolism of some drugs, leading to toxic
effects of drugs affected by these isoenzymes. Foods can alter all pharmacokinetic and
pharmacodynamic processes. Not all medications are absorbed better on an empty stomach; some
require certain foods to enhance absorption. Patient comfort is a concern, but it is not as
important as more severe and possibly life-threatening food and drug interactions.DIF:
Cognitive Level:
AnalysisREF: p. 39TOP: Nursing Process: Assessment MSC: NCLEX Client Needs Category:
Physiologic Integrity: Reduction of Risk Potential
25. A nurse is teaching a patient about a drug that induces P-glycoprotein. The nurse will explain
that this drug may cause which effect on other drugs?
a. Decreased absorption in the intestines
b. Decreased elimination through the kidneys
c. Increased brain exposure
d. Increased fetal absorption
ANS: B
Drugs that induce PGP can increase drug export from cells of the intestinal epithelium into the
intestinal lumen, thus decreasing absorption of the drug. PGP inducers also increase drug
11 | P a g eelimination and decrease brain and fetal drug exposure.DIF: Cognitive Level: AnalysisREF: p.
36TOP: Nursing Process: Assessment MSC: NCLEX Client Needs Category: Physiologic Integrity:
Pharmacologic and Parenteral Therapies
26. 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?
a. 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: ApplicationREF: p. 19TOP: Nursing Process:
Diagnosis MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral
Therapies
27. Two nurses are discussing theories of drug-receptor interaction. Which statements are true
regarding the affinity of a drug and its receptor?
Select all that apply.
a. Affinity and intrinsic activity are dependent properties.
b. Affinity refers to the strength of the attraction between a drug and its receptor.
c. Drugs with high affinity are strongly attracted to their receptors.
d. Drugs with low affinity are strongly attracted to their receptors.
e. The affinity of a drug for its receptors is reflected in its potency.
ANS: B , C , E
Affinity refers to the strength of the attraction between a drug and its receptor. Drugs with high
affinity are strongly attracted to their receptors, and the affinity of a drug and its receptors is
reflected in its potency. Affinity and intrinsic activity are independent properties. Drugs with low
affinity are weakly attracted to their receptors.DIF: Cognitive Level: ComprehensionREF: pp. 30-
31TOP: Nursing Process: Diagnosis MSC: NCLEX Client Needs Category: Physiologic Integrity:
Pharmacologic and Parenteral Therapies
28. 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.
12 | P a g ed. 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 for them to take effect, which is a function of a drug’s half-life and
dosing frequency.DIF: Cognitive Level: ApplicationREF: p. 25TOP: Nursing Process: Evaluation MSC:
NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential
29. What occurs when a drug binds to a receptor in the body?
a. It alters the receptor to become nonresponsive to its usual endogenous molecules.
b. It increases or decreases the activity of that receptor.
c. It gives the receptor a new function.
d. It prevents the action of the receptor by altering its response to chemical mediators.
ANS: B
When a drug binds to a receptor, it mimics or blocks the actions of the usual endogenous regulatory
molecules, either increasing or decreasing the rate of the physiologic activity normally controlled
by that receptor. It does not alter the activity of the receptor and does not give the receptor a
new function.DIF: Cognitive Level: AnalysisREF: p. 29TOP: Nursing Process: Assessment MSC:
NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral Therapies
30. A patient is receiving intravenous gentamicin. A serum drug test reveals toxic levels. The
dosing is correct, and this medication has been tolerated by this patient in the past. Which could
be a probable cause of the test result?
a. A loading dose was not given.
b. The drug was not completely dissolved in the IV solution.
c. The patient is taking another medication that binds to serum albumin.
d. The medication is being given at a frequency that is longer than its half-life.
ANS: C
Gentamicin binds to albumin, but only weakly, and in the presence of another drug that binds to
albumin, it can rise to toxic levels in blood serum. A loading dose increases the initial amount of a
drug and is used to bring drug levels to the desired plateau more quickly. A drug that is not
completely dissolved carries a risk of causing embolism. A drug given at a frequency longer than
the drug half-life will likely be at subtherapeutic levels and not at toxic levels.DIF: Cognitive Level:
AnalysisREF: p. 21TOP: Nursing Process: Evaluation MSC: NCLEX Client Needs Category:
Physiologic Integrity: Reduction of Risk Potential
31. A patient reports becoming “immune” to a medication because it no longer works to alleviate
symptoms. The nurse recognizes that this decreased effectiveness is likely caused by:
a. antagonists produced by the body that compete with the drug for receptor sites.
b. decreased selectivity of receptor sites, resulting in a variety of effects.
c. desensitization of receptor sites by continual exposure to the drug.
13 | P a g ed. synthesis of more receptor sites in response to the medication.
ANS: C
Continual exposure to an agonist would cause the cell to become less responsive or desensitized.
The body does not produce antagonists as a response to a medication. Receptor site selectivity is
determined by physiologic factors and not by the substances that bind to them. Medications do not
cause more receptors to be produced.DIF: Cognitive Level: AnalysisREF: p. 32-33TOP: Nursing
Process: Diagnosis MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic and
Parenteral Therapies
32. A patient who is taking morphine for pain asks the nurse how a pain medication can also cause
constipation. What does the nurse know about morphine?
a. It binds to different types of receptors in the body.
b. It can cause constipation in toxic doses.
c. It causes only one type of response, and the constipation is coincidental.
d. It is selective to receptors that regulate more than one body process.
ANS: D
Morphine is a medication that is selective to receptor type that regulates more than one process.
Because it is selective to receptor type, it does not bind to different types of receptors. Constipation
is a normal side effect and is not significant for toxicity.DIF: Cognitive Level: AnalysisREF: p.
35TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic
Integrity: Pharmacologic and Parenteral Therapies
33. The nurse is administering morning medications. The nurse gives a patient multiple
medications, two of which compete for plasma albumin receptor sites. As a result of this
concurrent administration, the nurse can anticipate that what might occur?
Select all that apply.
a. Binding of one or both agents will be reduced.
b. Plasma levels of free drug will rise.
c. Plasma levels of free drug will fall.
d. The increase in free drug will intensify effects.
e. The increase in bound drug will intensify effects.
ANS: A , B , D
When two drugs bind to the same site on plasma albumin, coadministration of those drugs produces
competition for binding. As a result, binding of one or both agents is reduced, causing plasma
levels of free drug to rise. The increase in free drug can intensify the effect, but it usually undergoes
rapid elimination. The increase in plasma levels of free drug is rarely sustained.DIF: Cognitive
Level: AnalysisREF: p. 36TOP: Nursing Process: Diagnosis MSC: NCLEX Client Needs Category:
Physiologic Integrity: Pharmacologic and Parenteral Therapies
34. When administering medications to infants, it is important to remember which of the
following?
Select all that apply.
a. Breast-feeding infants are more likely to develop toxicity when given lipid-soluble drugs.
b. Immaturity of renal function in infancy causes infants to excrete drugs less efficiently.
14 | P a g ec. Infants have immature livers, which slows drug metabolism.
d. Infants are more sensitive to medications that act on the central nervous system (CNS).
e. Oral medications are contraindicated in infants, because PO administration requires a
cooperative patient.
ANS: B , C , D
Immature renal function causes infants to excrete drugs more slowly, and infants are at risk for
toxicity until renal function is well developed. Infants’ livers are not completely developed, and
they are less able to metabolize drugs efficiently. Because the blood-brain barrier is not well
developed in infants, caution must be used when administering CNS drugs. Lipid-soluble drugs
may be excreted in breast milk if the mother is taking them, but breastfeeding does not affect
medications given directly to the infant. Oral medications may be given safely to infants as long as
they are awake and can swallow the drug.DIF: Cognitive Level: ComprehensionREF: "pp.
20,22,24"TOP: Nursing Process: Assessment MSC: NCLEX Client Needs Category: Physiologic
Integrity: Reduction of Risk Potential
Chapter 5: Adverse Drug Reactions and Medication Errors
Multiple Choice
35. A nursing student is preparing to give a medication that has a boxed warning. The student asks
the nurse what this means. What will the nurse explain about boxed warnings?
a. They indicate that a drug should not be given except in life-threatening circumstances.
b. They provide detailed information about the adverse effects of the drug.
c. They alert prescribers to measures to mitigate potential harm from side effects.
d. They provide information about antidotes in the event that toxicity occurs.
ANS: C
Boxed warnings (also known as black box warnings) are used to alert providers to potential side
effects and to ways to prevent or reduce harm from these side effects. A boxed warning is placed
on any drug that, although useful, has serious side effects; this is a way to keep drugs on the market
while protecting patients. Many of these drugs are used in situations that are not life-threatening.
The boxed warning provides a concise summary and not a detailed explanation of drug side effects.
The boxed warning does not include antidotes to toxicity.DIF: Cognitive Level: AnalysisREF: p.
45TOP: Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic
Integrity: Reduction of Risk Potential
36. A nurse is preparing to administer a drug. Upon reading the medication guide, the nurse notes
that the drug has been linked to symptoms of Parkinson disease in some patients. What will
the nurse do?
a. Ask the patient to report these symptoms, which are known to be teratogenic effects.
b. Observe the patient closely for such symptoms and prepare to treat them if needed.
c. Request an order to evaluate the patient’s genetic predisposition to this effect.
d. Warn the patient about these effects and provide reassurance that this is expected.
ANS: B
A drug that causes disease-like symptoms is known to be iatrogenic. Nurses should be prepared
for this possibility and be prepared to withdraw the drug if necessary and treat the symptoms. Such
effects are not teratogenic, since teratogenic effects affect the fetus. Patients with a genetic
15 | P a g epredisposition to respond differently to drugs are known to have idiosyncratic effects. Iatrogenic
effects, even when known, are not typically expected side effects.DIF: Cognitive Level:
ApplicationREF: pp. 41-42TOP: Nursing Process: Diagnosis MSC: NCLEX Client Needs Category:
Physiologic Integrity: Pharmacologic and Parenteral Therapies
37. Which patients are at increased risk for adverse drug events?
Select all that apply.
a. A 2-month-old infant taking a medication for gastroesophageal reflux disease
b. A 23-year-old female taking an antibiotic for the first time
c. A 40-year-old male who is intubated in the intensive care unit and taking antibiotics and
cardiac medications
d. A 7-year-old female receiving insulin for diabetes
e. An 80-year-old male taking medications for COPD
ANS: A , C , E
Patients at incre [Show Less]