Basic Pharmacology for Nurses 17th Edition Test Bank

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Chapter 01: Drug Definitions, Standards, and Information SourcesClayton/Willihnganz: Basic Pharmacology for Nurses, 17th EditionMULTIPLE CHOICE1.What is the name under which a drug is listed by the U.S. Food and Drug Administration(FDA)?a.Brandb.Nonproprietaryc.Officiald.TrademarkANS:CThe official name is the name under which a drug is listed by the FDA. The brand name, ortrademark, is the name given to a drug by its manufacturer. The nonproprietary, or generic,name is provided by the U.S. Adopted Names Council.DIF:Cognitive Level: KnowledgeREF:Page 2OBJ:2TOP:Nursing Process Step: AssessmentMSC:NCLEX Client Needs Category: Safe, Effective Care EnvironmentNOT:CONCEPT(S): Patient Education2.Which source contains information specific to nutritional supplements?a.USP Dictionary of USAN & International Drug Namesb.Natural Medicines Comprehensive Databasec.United States Pharmacopoeia/National Formulary (USP NF)d.Drug Interaction FactsANS:CUnited States Pharmacopoeia/National Formularycontainsinformation specific to nutritionalsupplements.USP Dictionary of USAN & International Drug Namesis a compilation of drugnames, pronunciation guide, and possible future FDA approved drugs; it does not includenutritional supplements.Natural Medicines Comprehensive Databasecontains evidence basedinformation on herbal medicines and herbal combination products; it does not includeinformation specific to nutritional supplements.Drug Interaction Factscontainscomprehensive information on drug interaction facts; it does not include nutritionalsupplements.DIF:Cognitive Level: KnowledgeREF:Page 2 | Page 3OBJ:4TOP:Nursing Process Step: AssessmentMSC:NCLEX Client Needs Category: Physiological IntegrityNOT:CONCEPT(S): Nutrition; Patient Education3.What is the most comprehensive reference available to research a drug interaction?a.Drug Facts and Comparisonsb.Drug Interaction Factsc.Handbook on Injectable Drugsd.Martindale—The Complete Drug ReferenceANS:B

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First published in 1983,Drug Interaction Factsis the most comprehensive book available ondrug interactions. In addition to monographs listing various aspects of drug interactions, thisinformation is reviewed and updated by an internationally renowned group of physicians andpharmacists with clinical and scientific expertise.DIF:Cognitive Level: ComprehensionREF:Page 3OBJ:3TOP:Nursing Process Step: AssessmentMSC:NCLEX Client Needs Category: Physiological IntegrityNOT:CONCEPT(S): Safety; Patient Education; Clinical Judgment4.The physician has written an order for a drug with which the nurse is unfamiliar. Whichsection of thePhysicians’ Desk Reference (PDR)is most helpful to get information about thisdrug?a.Manufacturer’s sectionb.Brand and Generic Name sectionc.Product Category sectiond.Product Information sectionANS:BA physician’s order would include the brand and/or generic name of the drug. The alphabeticindex in thePDRwould make this section the most user friendly. Based on a physician’sorder, manufacturer’s information and classification information would not be known. TheManufacturer’s section is a roster of manufacturers. The Product Category section listsproducts subdivided by therapeutic classes, such as analgesics, laxatives, oxytocics, andantibiotics. The Product Information section contains reprints of the package inserts for themajor products of manufacturers.DIF:Cognitive Level: ComprehensionREF:Page 3OBJ:3TOP:Nursing Process Step: PlanningMSC:NCLEX Client Needs Category: Physiological IntegrityNOT:CONCEPT(S): Safety; Patient Education; Clinical Judgment5.Which online drug reference makes available to health care providers and the public astandard, comprehensive, up-to-date look up and downloadable resource about medicines?a.American Drug Indexb.American Hospital Formularyc.DailyMedd.Physicians’ Desk Reference (PDR)ANS:CDailyMed makes available to health care providers and the public a standard, comprehensive,up-to-date look up and downloadable resource about medicines. TheAmerican Drug Indexisnot appropriate for patient use. TheAmerican Hospital Formularyis not appropriate forpatient use. ThePDRis not appropriate for patient use.DIF:Cognitive Level: KnowledgeREF:Page 4OBJ:4TOP:Nursing Process Step: ImplementationMSC:NCLEX Client Needs Category: Physiological IntegrityNOT:CONCEPT(S): Safety; Patient Education; Clinical Judgment6.Which legislation authorizes the FDA to determine the safety of a drug before its marketing?a.Federal Food, Drug, and Cosmetic Act (1938)

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b.Durham Humphrey Amendment (1952)c.Controlled Substances Act (1970)d.Kefauver Harris Drug Amendment (1962)ANS:AThe Federal Food, Drug, and Cosmetic Act of 1938 authorized the FDA to determine thesafety of all drugs before marketing. Later amendments and acts helped tighten FDA controland ensure drug safety. The Durham Humphrey Amendment defines the kinds of drugs thatcannot be used safely without medical supervision and restricts their sale to prescription by alicensed practitioner. The Controlled Substances Act addresses only controlled substances andtheir categorization. The Kefauver Harris Drug Amendment ensures drug efficacy and greaterdrug safety. Drug manufacturers are required to prove to the FDA the effectiveness of theirproducts before marketing them.DIF:Cognitive Level: KnowledgeREF:Page 5OBJ:6TOP:Nursing Process Step: AssessmentMSC:NCLEX Client Needs Category: Physiological IntegrityNOT:CONCEPT(S): Safety; Patient Education; Evidence; Health Care Law7.Meperidine (Demerol) is a narcotic with a high potential for physical and psychologicaldependency. Under which classification does this drug fall?a.Ib.IIc.IIId.IVANS:BMeperidine (Demerol) is a Schedule II drug; it has a high potential for abuse and may lead tosevere psychological and physical dependence. Schedule I drugs have high potential for abuseand no recognized medical use. Schedule III drugs have some potential for abuse. Use maylead to low to moderate physical dependence or high psychological dependence. Schedule IVdrugs have low potential for abuse. Use may lead to limited physical or psychologicaldependence.DIF:Cognitive Level: ComprehensionREF:Page 5OBJ:1TOP:Nursing Process Step: AssessmentMSC:NCLEX Client Needs Category: Safe, Effective Care EnvironmentNOT:CONCEPT(S): Patient Education; Addiction; Pain8.What would the FDA do to expedite drug development and approval for an outbreak ofsmallpox, for which there is no known treatment?a.List smallpox as a health orphan disease.b.Omit the preclinical research phase.c.Extend the clinical research phase.d.Fast track the investigational drug.ANS:D

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Once the Investigational New Drug Application has been approved, the drug can receivehighest priority within the agency, which is called fast tracking. A smallpox outbreak wouldbecome a priority concern in the world. Orphan diseases are not researched in a prioritymanner. Preclinical research is not omitted. Extending any phase of the research would meana longer time to develop a vaccine. The FDA must ensure that all phases of the preclinical andclinical research phase have been completed in a safe manner.DIF:Cognitive Level: KnowledgeREF:Page 7OBJ:8TOP:Nursing Process Step: AssessmentMSC:NCLEX Client Needs Category: Safe, Effective Care EnvironmentNOT:CONCEPT(S): Health Care Law; Health Policy; Infection; Care Coordination9.Which statement is true about over-the-counter (OTC) drugs?a.They are not listed in theUSP NF.b.A prescription from a health care provider is needed.c.They are sold without a prescription.d.They are known only by their brand names.ANS:COTC medications do not require a prescription. A variety of names, both generic and trade,can be used for individual drugs sold OTC. OTC drugs are listed in theUSP NF. Prescriptiondrugs require an order by a health professional who is licensed to prescribe, such as aphysician, nurse practitioner, physician assistant, or dentist.DIF:Cognitive Level: ComprehensionREF:Page 2OBJ:5TOP:Nursing Process Step: PlanningMSC:NCLEX Client Needs Category: Physiological IntegrityNOT:CONCEPT(S): Patient Education10.Which is the most authoritative reference for medications that are injected?a.Physicians’ Desk Referenceb.Handbook on Injectable Drugsc.DailyMedd.Handbook of Nonprescription DrugsANS:BTheHandbook on Injectable Drugsis the most comprehensive reference available on thetopic of compatibility of injectable drugs. It is a collection of monographs for more than300injectable drugs that are listed alphabetically by generic name.DIF:Cognitive Level: ComprehensionREF:Page 3OBJ:3TOP:Nursing Process Step: AssessmentMSC:NCLEX Client Needs Category: Physiological IntegrityNOT:CONCEPT(S): Clinical Judgment; Safety11.The nurse is administering Lomotil, a Schedule V drug. Which statement is true about thisdrug’s classification?a.Abuse potential for this drug is low.b.Psychological dependency is likely.c.There is a high potential for abuse.d.This drug is not a controlled substance.

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ANS:ALomotil, a Schedule V drug, has an abuse potential of limited physical or psychologicaldependence liability compared with drugs in Schedule IV. Because abuse potential is low witha Schedule V drug, a prescription may not be required. Psychological dependency is not likelywith a Schedule V drug. Schedule V drugs are classified as controlled substances.DIF:Cognitive Level: KnowledgeREF:Page 5OBJ:2TOP:Nursing Process Step: AssessmentMSC:NCLEX Client Needs Category: Physiological IntegrityNOT:CONCEPT(S): Clinical Judgment; Safety; Patient Education12.The nurse is transcribing new orders written for a patient with a substance abuse history.Choose the medication ordered that has the greatest risk for abuse.a.Lomotilb.Diazepamc.Phenobarbitald.LortabANS:DLortab is a Schedule III drug with a high potential for abuse but less so than drugs inSchedules I and II. Lomotil is a Schedule V drug with a low potential for abuse comparedwith those in Schedule V. Diazepam is a Schedule IV drug with a low potential for abusecompared with those in schedule III. Phenobarbital is a Schedule IV drug with a low potentialfor abuse compared with those in Schedule III.DIF:Cognitive Level: ApplicationREF:Page 5OBJ:2TOP:Nursing Process Step: AssessmentMSC:NCLEX Client Needs Category: Physiological IntegrityNOT:CONCEPT(S): Addiction; Patient Education; SafetyMULTIPLE RESPONSE1.An older adult experiencing shortness of breath is brought to the hospital by her daughter.While obtaining the medication history from the patient and her daughter, the nurse discoversthat neither has a list of the patient’s current medications or prescriptions. All the patient hasis a weekly pill dispenser that contains four different pills. The prescriptions are filled throughthe local pharmacy. Which resource(s) would be appropriate to use in determining themedication names and doses? (Select all that apply.)a.Martindale—The Complete Drug Referenceb.Physicians’ Desk Reference,Section 4c.Senior citizens’ centerd.Patient’s home pharmacyANS:B, DThePhysicians’ Desk Reference,Section 4, has full color images of commonly dispensedtablets and capsules. The patient’s pharmacy would have an accurate account of all themedications the client is currently taking.Martindale—The Complete Drug Referencehaswritten information on medications and would not be an appropriate resource. The seniorcitizens’ center is not likely to have specific patient medication information.DIF:Cognitive Level: ApplicationREF:Page 3OBJ:3

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TOP:Nursing Process Step: AssessmentMSC:NCLEX Client Needs Category: Physiological IntegrityNOT:CONCEPT(S): Care Coordination; Safety; Patient Education; Clinical Judgment2.The nurse planning patient teaching regarding drug names would include which statement(s)?(Select all that apply.)a.Most drug companies place their products on the market under generic names.b.The official name is the name under which the drug is listed by the U.S. Food andDrug Administration (FDA).c.Brand names are easier to pronounce, spell, and remember.d.The first letter of the generic name is not capitalized.e.The chemical name is most meaningful to the patient.ANS:B, C, DThe official name is the name under which the drug is listed by the FDA. Brand names areeasier to pronounce, spell, and remember. The first letter of the generic name is notcapitalized. Most drug companies place their products on the market under brand namesinstead of generic names. The chemical name is most meaningful to the chemist.DIF:Cognitive Level: ApplicationREF:Page 1 | Page 2OBJ:1TOP:Nursing Process Step: PlanningMSC:NCLEX Client Needs Category: Physiological IntegrityNOT:CONCEPT(S): Patient Education; Clinical Judgment; Safety3.When categorizing, the nurse is aware that which drug(s) would be considered Schedule II?(Select all that apply.)a.Marijuanab.Percodanc.Amphetaminesd.Fiorinale.FlurazepamANS:B, CSchedule II drugs have a high potential for abuse, they are currently accepted in the UnitedStates, and use may lead to severe psychological or physical dependence. Percodan andamphetamines are considered Schedule II drugs. Marijuana is a Schedule I drug. Fiorinal is aSchedule III drug. Flurazepam is a Schedule IV drug.DIF:Cognitive Level: AnalysisREF:Page 5OBJ:2TOP:Nursing Process Step: AssessmentMSC:NCLEX Client Needs Category: Physiological IntegrityNOT:CONCEPT(S): Addiction; Clinical Judgment; Patient Education

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Chapter 02: Basic Principles of Drug Action and Drug InteractionsClayton/Willihnganz: Basic Pharmacology for Nurses, 17th EditionMULTIPLE CHOICE1.The nurse assesses hives in a patient started on a new medication. What is the nurse’s priorityaction?a.Notify physician of allergic reaction.b.Notify physician of idiosyncratic reaction.c.Notify physician of potential teratogenicity.d.Notify physician of potential tolerance.ANS:AAn allergic reaction is indicative of hypersensitivity and manifests with hives and/or urticaria,which are easily identified. An idiosyncratic reaction occurs when something unusual orabnormal happens when a drug is first administered. A teratogenic reaction refers to theoccurrence of birth defects related to administration of the drug. Tolerance refers to the body’srequirement for increasing dosages to achieve the same effects that a lower dose once did.DIF:Cognitive Level: ApplicationREF:Page 17OBJ:4TOP:Nursing Process Step: AssessmentMSC:NCLEX Client Needs Category: Physiological IntegrityNOT:CONCEPT(S): Clinical Judgment; Safety2.The nurse administers an initial dose of a steroid to a patient with asthma. Thirty minutes afteradministration, the nurse finds the patient agitated and stating that “everyone is out to get me.”What is the term for this unusual reaction?a.Desired actionb.Adverse effectc.Idiosyncratic reactiond.Allergic reactionANS:CIdiosyncratic reactions are unusual, abnormal reactions that occur when a drug is firstadministered. Patients typically exhibit an overresponsiveness to a medication related todiminished metabolism. These reactions are believed to be related to genetic enzymedeficiencies. Desired actions are expected responses to a medication. Adverse effects arereactions that occur in another system of the body; they are usually predictable. Allergicreactions appear after repeated medication dosages.DIF:Cognitive Level: KnowledgeREF:Page 18OBJ:4TOP:Nursing Process Step: EvaluationMSC:NCLEX Client Needs Category: Physiological IntegrityNOT:CONCEPT(S): Patient Education; Clinical Judgment; Caregiving; Safety; Sensory Perception3.Which is the best description of when drug interactions occur?a.On administration of toxic dosages of a drugb.On an increase in the pharmacodynamics of bound drugsc.On the alteration of the effect of one drug by another drugd.On increase of drug excretion

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ANS:CDrug interactions may be characterized by an increase or decrease in the effectiveness of oneor both of the drugs. Toxicity of one drug may or may not affect the metabolism of anotherone. Drug interactions may result from either increased or decreased pharmacodynamics.Drug interactions may result from either increased or decreased excretion.DIF:Cognitive Level: ComprehensionREF:Page 18OBJ:5TOP:Nursing Process Step: AssessmentMSC:NCLEX Client Needs Category: Physiological IntegrityNOT:CONCEPT(S): Safety; Patient Education; Clinical Judgment4.What occurs when two drugs compete for the same receptor site, resulting in increasedactivity of the first drug?a.Desired actionb.Synergistic effectc.Carcinogenicityd.DisplacementANS:DThe displacement of the first drug from receptor sites by a second drug increases the amountof the first drug because more unbound drug is available. An expected response of a drug isthe desired action. A synergistic effect is the effect of two drugs being greater than the effectof each chemical individually or the sum of the individual effects. Carcinogenicity is theability of a drug to cause cells to mutate and become cancerous.DIF:Cognitive Level: ComprehensionREF:Page 19OBJ:6TOP:Nursing Process Step: ImplementationMSC:NCLEX Client Needs Category: Physiological IntegrityNOT:CONCEPT(S): Safety; Patient Education5.What do drug blood levels indicate?a.They confirm if the patient is taking a generic form of a drug.b.They determine if the patient has sufficient body fat to metabolize the drug.c.They verify if the patient is taking someone else’s medications.d.They determine if the amount of drug in the body is in a therapeutic range.ANS:DThe amount of drug present may vary over time and the blood level must remain in atherapeutic range in order to obtain the desired result. Generic drugs do not necessarilyproduce a different drug blood level than proprietary medications. Body fat is not measuredby drug blood levels. Drug blood levels only measure the amount of drug in the body; they donot determine the source of the medication.DIF:Cognitive Level: ComprehensionREF:Page 17OBJ:4TOP:Nursing Process Step: EvaluationMSC:NCLEX Client Needs Category: Physiological IntegrityNOT:CONCEPT(S): Clinical Judgment; Safety6.What is the process by which a drug is transported by circulating body fluids to receptor sites?a.Osmosisb.Distributionc.Absorption

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d.BiotransformationANS:BDistribution refers to the ways in which drugs are transported by the circulating body fluids tothe sites of action (receptors), metabolism, and excretion. Osmosis is the process of movingsolution across a semipermeable membrane to equalize the dilution on each side. Absorptionis the process by which a drug is transferred from its site of entry into the body to thecirculating fluids for distribution. Biotransformation, also called metabolism, is the process bywhich the body inactivates drugs.DIF:Cognitive Level: ComprehensionREF:Page 15OBJ:3TOP:Nursing Process Step: PlanningMSC:NCLEX Client Needs Category: Physiological IntegrityNOT:CONCEPT(S): Patient Education; Clinical Judgment; Safety7.The nurse assesses which blood level to determine the amount of circulating medication in apatient?a.Peakb.Troughc.Drugd.TherapeuticANS:CWhen a drug is circulating in the blood, a blood sample may be drawn and assayed todetermine the amount of drug present; this is known as the drug blood level. Peak levels areonly those drug blood levels that are at their maximum before metabolism starts to decreasethe amount of circulating drug. Trough levels are only those drug blood levels that are at theirminimum when metabolism has decreased the amount of circulating drug and before anincrease caused by a subsequent dose of the medication. Therapeutic levels are only thosewithin a prescribed range of blood levels determined to bring about effective action of themedication.DIF:Cognitive Level: ComprehensionREF:Page 17OBJ:3TOP:Nursing Process Step: EvaluationMSC:NCLEX Client Needs Category: Physiological IntegrityNOT:CONCEPT(S): Patient Education; Clinical Judgment; Safety8.The nurse administers 50 mg of a drug at 6:00 AM that has a half-life of 8 hours. What timewill it be when 25 mg of the drug has been eliminated from the body?a.8:00 AMb.11:00 AMc.2:00 PMd.6:00 PMANS:CFifty percent of the medication, or 25 mg, will be eliminated in 8 hours, or at2:00 PM. 8:00AM is 2 hours after administration; the half-life is 8 hours. 11:00 AM is 4 hours afteradministration; the half-life is 8 hours. 6:00 PM is 12 hours after administration; the half-lifeis 8 hours.DIF:Cognitive Level: AnalysisREF:Page 15OBJ:2TOP:Nursing Process Step: Evaluation

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MSC:NCLEX Client Needs Category: Physiological IntegrityNOT:CONCEPT(S): Clinical Judgment; Safety; Elimination; Health Promotion9.What will the nurse need to determine first in order to mix two drugs in the same syringe?a.Absorption rate of the drugsb.Compatibility of the drugsc.Drug blood level of each drugd.Medication adverse effectsANS:BKnowledge of absorption is important but not in order to mix drugs. In order to mix twodrugs, compatibility is determined so there is no deterioration when the drugs are mixed in thesame syringe. Drug level does not indicate if it is acceptable to mix medications in the samesyringe. Adverse effects are important for the nurse to know, but not in order to mix drugs.DIF:Cognitive Level: ApplicationREF:Page 19OBJ:6TOP:Nursing Process Step: ImplementationMSC:NCLEX Client Needs Category: Physiological IntegrityNOT:CONCEPT(S): Clinical Judgment; Safety10.A patient developed hives and itching after receiving a drug for the first time. Whichinstruction by the nurse is accurate?a.Stop the medication and encourage the patient to wear a medical alert bracelet thatexplains the allergy.b.Explain to the patient that these are signs and symptoms of an anaphylacticreaction.c.Emphasize to the patient the importance to inform medical personnel that in thefuture a lower dosage of this drug is necessary.d.Instruct the patient that it would be safe to take the drug again because thisinstance was a mild reaction.ANS:AThis initial allergic reaction is mild, and the patient is more likely to have an anaphylacticreaction at the next exposure; a medical alert bracelet is necessary to explain the reaction.Signs and symptoms of an anaphylactic reaction are respiratory distress and cardiovascularcollapse. A more severe reaction will occur at the next exposure, and the patient should notreceive the drug again.DIF:Cognitive Level: ApplicationREF:Page 18OBJ:4TOP:Nursing Process Step: ImplementationMSC:NCLEX Client Needs Category: Physiological IntegrityNOT:CONCEPT(S): Patient Education; Clinical Judgment; Safety11.When obtaining a patient’s health history, which assessment data would the nurse identify ashaving the most effect on drug metabolism?a.History of liver diseaseb.Intake of a vegetarian dietc.Sedentary lifestyled.Teacher as an occupationANS:A

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Liver enzyme systems are the primary site for metabolism of drugs. Intake of a vegetarian dietmay affect absorption but not metabolism. Sedentary lifestyle and occupations could affectmetabolism (exposure to environmental pollutants), but these do not have the most significanteffect on metabolism.DIF:Cognitive Level: ApplicationREF:Page 16OBJ:3TOP:Nursing Process Step: AssessmentMSC:NCLEX Client Needs Category: Physiological IntegrityNOT:CONCEPT(S): Patient Education; Clinical Judgment; Safety12.A physician’s order indicates to administer a medication to the patient via the percutaneousroute. The nurse can anticipate that the patient will receive this medicationa.intramuscularly.b.subcutaneously.c.topically.d.rectally.ANS:CThe percutaneous route refers to drugs that are absorbed through the skin and mucousmembranes. Methods of the percutaneous route include inhalation, sublingual (under thetongue), or topical (on the skin) administration. The parenteral route bypasses thegastrointestinal (GI) tract by using subcutaneous (subcut), intramuscular (IM), or intravenous(IV) injection. The parenteral route bypasses the GI tract by using subcut, IM, or IV injection.In the enteral route, the drug is administered directly into the GI tract by the oral, rectal, ornasogastric route.DIF:Cognitive Level: ApplicationREF:Page 14OBJ:1TOP:Nursing Process Step: ImplementationMSC:NCLEX Client Needs Category: Physiological IntegrityNOT:CONCEPT(S): Patient Education; Clinical Judgment; Safety13.A nurse is preparing to administer tetracycline to a patient diagnosed with an infection. Whichmedication should not be administered with tetracycline?a.Ativanb.Tylenolc.Colaced.MylantaANS:DAdministering tetracycline with Mylanta can provide an antagonistic effect that will result indecreased absorption of the tetracycline. Ativan, Tylenol, and Colace are not contraindicatedto administer with tetracycline.DIF:Cognitive Level: ApplicationREF:Page 18OBJ:5 | 6TOP:Nursing Process Step: ImplementationMSC:NCLEX Client Needs Category: Physiological IntegrityNOT:CONCEPT(S): Patient Education; Clinical Judgment; SafetyMULTIPLE RESPONSE1.Which statement(s) about liberation of drugs is/are true? (Select all that apply.)

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a.A drug must be dissolved in body fluids before it can be absorbed into bodytissues.b.A solid drug taken orally must disintegrate and dissolve in GI fluids to allow forabsorption into the bloodstream for transport to the site of action.c.The process of converting the drug into a soluble form can be controlled to acertain degree by the dosage form.d.Converting the drug to a soluble form can be influenced by administering the drugwith or without food in the patient’s stomach.e.Elixirs take longer to be liberated from the dosage form.ANS:A, B, C, DRegardless of the route of administration, a drug must be dissolved in body fluids before it canbe absorbed into body tissues. Before a solid drug taken orally can be absorbed into thebloodstream for transport to the site of action, it must disintegrate and dissolve in the GI fluidsand be transported across the stomach or intestinal lining into the blood. The process ofconverting a drug into a soluble form can be partially controlled by the pharmaceutical dosageform used (e.g., solution, suspension, capsules, and tablets with various coatings). Theconversion process can also be influenced by administering the drug with or without food inthe patient’s stomach. Elixirs are already drugs dissolved in a liquid and do not need to beliberated from the dosage form.DIF:Cognitive Level: ComprehensionREF:Page 14OBJ:3TOP:Nursing Process Step: ImplementationMSC:NCLEX Client Needs Category: Physiological IntegrityNOT:CONCEPT(S): Patient Education; Clinical Judgment; Safety2.Which are routes of drug excretion? (Select all that apply.)a.GI tract; fecesb.Genitourinary (GU) tract; urinec.Lymphatic systemd.Circulatory system; blood/plasmae.Respiratory system; exhalationANS:A, B, EThe GI system is a primary route for drug excretion. The GU and the respiratory systems dofunction in the excretion of drugs. The lymphatic and circulatory systems are involved withdrug distribution, not drug excretion.DIF:Cognitive Level: KnowledgeREF:Page 15OBJ:3TOP:Nursing Process Step: AssessmentMSC:NCLEX Client Needs Category: Physiological IntegrityNOT:CONCEPT(S): Patient Education; Clinical Judgment; Safety; Elimination3.Which route(s) enable(s) drug absorption more rapidly than the subcut route? (Select all thatapply.)a.IV routeb.IM routec.Inhalation/sublinguald.Intradermal routee.Enteral routeANS:A, B, C

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IV route of administration enables drug absorption more rapidly than the subcut route. IMroute of administration enables drug absorption more rapidly because of greater blood flowper unit weight of muscle. Inhalation/sublingual route of administration enables drugabsorption more rapidly than the subcut route. Intradermally administered drugs are absorbedmore slowly because of the limited available blood supply in the dermis. Enterallyadministered drugs are absorbed more slowly because of the biotransformation process.DIF:Cognitive Level: ComprehensionREF:Page 14OBJ:1 | 3TOP:Nursing Process Step: EvaluationMSC:NCLEX Client Needs Category: Physiological IntegrityNOT:CONCEPT(S): Patient Education; Clinical Judgment; Safety4.The nurse recognizes that which factor(s) would contribute to digoxin toxicity in a92-year-old patient? (Select all that apply.)a.Taking the medication with mealsb.Prolonged half-life of the drug digoxinc.Impaired renal functiond.Diminished mental capacityANS:B, CImpaired renal and hepatic function in older adults impairs metabolism and excretion ofdrugs, thus prolonging the half-life of a medication. Food would decrease the absorption ofthe drug. Diminished mental capacity does not contribute to drug toxicity unless it is due toadministration errors.DIF:Cognitive Level: ApplicationREF:Page 15OBJ:2 | 3 | 7TOP:Nursing Process Step: AssessmentMSC:NCLEX Client Needs Category: Health Promotion and MaintenanceNOT:CONCEPT(S): Patient Education; Clinical Judgment; Safety5.Which statement(s) about variables that influence drug action is/are true? (Select all thatapply.)a.An older adult will require increased dosage of a drug to achieve the sametherapeutic effect as that seen in a younger person.b.Body weight can affect the therapeutic response of a medication.c.Chronic smokers may metabolize drugs more rapidly than nonsmokers.d.A patient’s attitude and expectations affect the response to medication.e.Reduced circulation causes drugs to absorb more rapidly.ANS:B, C, DBody weight can affect response to medications; typically, obese patients require an increasein dosage and underweight patients a decrease in dosage. Chronic smoking enhancesmetabolism of drugs. Attitudes and expectations play a major role in an individual’s responseto drugs. Older adults require decreased dosages of drugs to achieve a therapeutic effect.Decreased circulation causes drugs to absorb more slowly.DIF:Cognitive Level: ComprehensionREF:Page 16 | Page 17OBJ:5 | 6 | 7TOP:Nursing Process Step: ImplementationMSC:NCLEX Client Needs Category: Physiological IntegrityNOT:CONCEPT(S): Patient Education; Clinical Judgment; Safety6.Which factor(s) affect(s) drug actions? (Select all that apply.)

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a.Teratogenicityb.Agec.Body weightd.Metabolic ratee.IllnessANS:B, C, D, EAge, body weight, metabolic rate, and illness may contribute to a variable response to amedication. Teratogenicity does not contribute to a variable response to a medication.DIF:Cognitive Level: ComprehensionREF:Page 16 | Page 17OBJ:7TOP:Nursing Process Step: AssessmentMSC:NCLEX Client Needs Category: Physiological IntegrityNOT:CONCEPT(S): Patient Education; Clinical Judgment; SafetyCOMPLETION1.A patient receives 200 mg of a medication that has a half-life of 12 hours. How many mg ofthe drug would remain in the patient’s body after 24 hours?ANS:50The half-life is defined as the amount of time required for 50% of the drug to be eliminatedfrom the body. If a patient is given 200 mg of a drug that has a half-life of 12 hours, then 50mg of the drug would remain in the body after 24 hours.DIF:Cognitive Level: AnalysisREF:Page 15OBJ:2 | 3TOP:Nursing Process Step: EvaluationMSC:NCLEX Client Needs Category: Physiological IntegrityNOT:CONCEPT(S): Clinical Judgment; Safety

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Chapter 03: Drug Action Across the Life SpanClayton/Willihnganz: Basic Pharmacology for Nurses, 17th EditionMULTIPLE CHOICE1.What time will the trough blood level need to be drawn if the nurse administers theintravenous medication dose at 9:00 AM?a.6:30 AMb.8:30 AMc.9:30 AMd.11:30 AMANS:BTrough blood levels measure the lowest blood level of medicine and are obtained just beforethe dose is administered. In this case, 6:30 AM is too early to obtain the blood level. The othertwo times occur after the medication is administered.DIF:Cognitive Level: ApplicationREF:Page 27OBJ:2TOP:Nursing Process Step: ImplementationMSC:NCLEX Client Needs Category: Physiological IntegrityNOT:CONCEPT(S): Clinical Judgment; Safety2.What will the nurse expect the health care provider’s order to be when starting an older adultpatient on thyroid hormone replacement therapy?a.Administering a loading dose of the drugb.Directions on how to taper the drugc.A dosage that is one third to one half of the regular dosaged.A dosage that is double the regular dosageANS:CTo prevent toxicity, dosages for new medications in older adults should be one third to onehalf the amount of a standard adult dosage. Loading doses of drugs could cause severetoxicity. Tapering off is characteristic of discontinuation of medications and is not appropriatefor this situation. Older adults generally need a lower medication dosage than youngerpatients.DIF:Cognitive Level: ApplicationREF:Page 29OBJ:3TOP:Nursing Process Step: ImplementationMSC:NCLEX Client Needs Category: Physiological IntegrityNOT:CONCEPT(S): Clinical Judgment; Safety; Patient Education; Development3.Which drugs cause birth defects?a.Teratogensb.Carcinogensc.Metabolitesd.PlacebosANS:ATeratogens are drugs that cause birth defects. Carcinogens cause cancer. Metabolites are theend product of metabolism. Placebos are drugs that have no pharmacologic activity.

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