Focus on Nursing Pharmacology Seventh, North American Edition Test Bank

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1.
Chapter 1
A nurse working in radiology administers iodine to a patient who is having a computed
tomography (CT) scan. The nurse working on the oncology unit administers chemotherapy to
patients who have cancer. At the Public Health Department, a nurse administers a measles-
mumps-rubella (MMR) vaccine to a 14-month-old child as a routine immunization. Which branch
of pharmacology best describes the actions of all three nurses?
A) Pharmacoeconomics
B) Pharmacotherapeutics
C) Pharmacodynamics
D) Pharmacokinetics
Ans: B
Feedback:
Pharmacology is the study of the biologic effects of chemicals. Nurses are involved with clinical
pharmacology or pharmacotherapeutics, which is a branch of pharmacology that deals with the
uses of drugs to treat, prevent, and diagnose disease. The radiology nurse is administering a drug
to help diagnose a disease. The oncology nurse is administering a drug to help treat a disease.
Pharmacoeconomics includes any costs involved in drug therapy. Pharmacodynamics involves
how a drug affects the body and pharmacokinetics is how the body acts on the body.
2.
A physician has ordered intramuscular (IM) injections of morphine, a narcotic, every 4 hours as
needed for pain in a motor vehicle accident victim. The nurse is aware this drug has a high abuse
potential. Under what category would morphine be classified?
A) Schedule I
B) Schedule II

C) Schedule III
D) Schedule IV
Ans: B
Feedback:
Narcotics with a high abuse potential are classified as Schedule II drugs because of severe
dependence liability. Schedule I drugs have high abuse potential and no accepted medical use.
Schedule III drugs have a lesser abuse potential than II and an accepted medical use. Schedule IV
drugs have low abuse potential and limited dependence liability.
3. When involved in phase III drug evaluation studies, what responsibilities would the nurse have?
A) Working with animals who are given experimental drugs
B) Choosing appropriate patients to be involved in the drug study
C) Monitoring and observing patients closely for adverse effects
D) Conducting research to determine effectiveness of the drug
Ans: C
Feedback:
Phase III studies involve use of a drug in a vast clinical population in which patients are asked to
record any symptoms they experience while taking the drugs. Nurses may be responsible for
helping collect and analyze the information to be shared with the Food and Drug Administration
(FDA) but would not conduct research independently because nurses do not prescribe
medications. Use of animals in drug testing is done in the preclinical trials. Select patients who
are involved in phase II studies to participate in studies where the participants have the disease
the drug is intended to treat. These patients are monitored closely for drug action and adverse
effects. Phase I studies involve healthy human volunteers who are usually paid for their
participation. Nurses may observe for adverse effects and toxicity.
4. What concept is considered when generic drugs are substituted for brand name drugs?

A) Bioavailability
B) Critical concentration
C) Distribution
D) Half-life
Ans: A
Feedback:
Bioavailability is the portion of a dose of a drug that reaches the systemic circulation and is
available to act on body cells. Binders used in a generic drug may not be the same as those used
in the brand name drug. Therefore, the way the body breaks down and uses the drug may differ,
which may eliminate a generic drug substitution. Critical concentration is the amount of a drug
that is needed to cause a therapeutic effect and should not differ between generic and brand name
medications. Distribution is the phase of pharmacokinetics, which involves the movement of a
drug to the bodys tissues and is the same in generic and brand name drugs. A drugs half-life is the
time it takes for the amount of drug to decrease to half the peak level, which should not change
when substituting a generic medication.
5.
A nurse is assessing the patients home medication use. After listening to the patient list current
medications, the nurse asks what priority question?
A) Do you take any generic medications?
B) Are any of these medications orphan drugs?
C) Are these medications safe to take during pregnancy?
D) Do you take any over-the-counter medications?
Ans: D
Feedback:

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It is important for the nurse to specifically question use of over-the-counter medications because
patients may not consider them important. The patient is unlikely to know the meaning of orphan
drugs unless they too are health care providers. Safety during pregnancy, use of a generic
medication, or classification of orphan drugs are things the patient would be unable to answer but
could be found in reference books if the nurse wishes to research them.
6. After completing a course on pharmacology for nurses, what will the nurse know?
A) Everything necessary for safe and effective medication administration
B) Current pharmacologic therapy; the nurse will not require ongoing education for 5 years.
C)
General drug information; the nurse can consult a drug guide for specific drug
information.
D) The drug actions that are associated with each classification of medication
Ans: C
Feedback:
After completing a pharmacology course nurses will have general drug information needed for
safe and effective medication administration but will need to consult a drug guide for specific
drug information before administering any medication. Pharmacology is constantly changing,
with new drugs entering the market and new uses for existing drugs identified. Continuing
education in pharmacology is essential to safe practice. Nurses tend to become familiar with the
medications they administer most often, but there will always be a need to research new drugs
and also those the nurse is not familiar with because no nurse knows all medications.
7.
A nurse is instructing a pregnant patient concerning the potential risk to her fetus from a
Pregnancy Category B drug. What would the nurse inform the patient?
A) Adequate studies in pregnant women have demonstrated there is no risk to the fetus.
B)
Animal studies have not demonstrated a risk to the fetus, but there have been no adequate
studies in pregnant women.

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C)
Animal studies have shown an adverse effect on the fetus, but there are no adequate
studies in pregnant women.
D)
There is evidence of human fetal risk, but the potential benefits from use of the drug may
be acceptable despite potential risks.
Ans: B
Feedback:
Category B indicates that animal studies have not demonstrated a risk to the fetus. However, there
have not been adequate studies in pregnant women to demonstrate risk to a fetus during the first
trimester of pregnancy and no evidence of risk in later trimesters. Category A indicates that
adequate studies in pregnant women have not demonstrated a risk to the fetus in the first trimester
or in later trimesters. Category C indicates that animal studies have shown an adverse effect on
the fetus, but no adequate studies in humans. Category D reveals evidence of human fetal risk,
but the potential benefits from the use of the drugs in pregnant women may outweigh potential
risks.
8.
Discharge planning for patients leaving the hospital should include instructions on the use of
over-the-counter (OTC) drugs. Which comment by the patient would demonstrate a good
understanding of OTC drugs?
A) OTC drugs are safe and do not cause adverse effects if taken properly.
B)
OTC drugs have been around for years and have not been tested by the Food and Drug
Administration (FDA).
C) OTC drugs are different from any drugs available by prescription and cost less.
D) OTC drugs could cause serious harm if not taken according to directions.
Ans: D
Feedback:

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It is important to follow package directions because OTCs are medications that can cause serious
harm if not taken properly. OTCs are drugs that have been determined to be safe when taken as
directed; however, all drugs can produce adverse effects even when taken properly. They may
have originally been prescription drugs that were tested by the FDA or they may have been
grandfathered in when the FDA laws changed. OTC education should always be included as a
part of the hospital discharge instructions.
9. What would be the best source of drug information for a nurse?
A) Drug Facts and Comparisons
B) A nurses drug guide
C) A drug package insert
D) The Physicians Drug Reference (PDR)
Ans: B
Feedback:
A nurses drug guide provides nursing implications and patient teaching points that are most
useful to nurses in addition to need-to-know drug information in a very user friendly
organizational style.Lippincotts Nursing Drug Guide (LNDG) has drug monographs organized
alphabetically and includes nursing implications and patient teaching points. Numerous other
drug handbooks are also on the market and readily available for nurses to use. Although other
drug reference books such as Drug Facts and Comparisons, PDR, and drug package inserts can
all provide essential drug information, they will not contain nursing implications and teaching
points and can be more difficult to use than nurses drug guides.
10.
The nurse is preparing to administer a medication from a multidose bottle. The label is torn and
soiled but the name of the medication is still readable. What is the nurses priority action?
A) Discard the entire bottle and contents and obtain a new bottle.
B) Find the drug information and create a new label for the bottle.

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C) Ask another nurse to verify the contents of the bottle.
D) Administer the medication if the name of the drug can be clearly read.
Ans: A
Feedback:
When the drug label is soiled obscuring some information the safest action by the nurse is to
discard the bottle and contents because drug labels contain a great deal of important
information, far more than just the name of the drug. Concentration of the drug, expiration date,
administration directions, and precautions may be missing from the label and so put the patient
at risk. Looking up drug information in a drug handbook or consulting with another nurse will
not supply the expiration date or concentration of medication. Be safe and discard the bottle and
its contents.
11. What aspect of pharmacology does a nurse study? (Select all that apply.)
A) Chemical pharmacology
B) Molecular pharmacology
C) Impact of drugs on the body
D) The bodys response to a drug
E) Adverse and anticipated drug effects
Ans: C, D, E
Feedback:
Nurses study pharmacology from a pharmacotherapeutic level, which includes the effect of
drugs on the body, the bodys response to drugs, and both expected and unexpected drug effects.
Chemical and molecular pharmacology (Options A and B) are not included in nursing
pharmacology courses.

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12.
The nurse, providing patient teaching about home medication use to an older adult, explains that
even when drugs are taken properly they can produce negative or unexpected effects. What are
these negative or unexpected effects called?
A) Teratogenic effects
B) Toxic effects
C) Adverse effects
D) Therapeutic effects
Ans: C
Feedback:
Negative or unexpected effects are known as adverse or side effects. Teratogenic effects are
adverse effects on the fetus and not a likely concern for an older adult. Toxic effects occur when
medication is taken in larger than recommended dosages caused by an increase in serum drug
levels. Therapeutic effects are the desired actions for which the medication is prescribed.
13. After administering a medication, for what would the nurse assess the patient?
A) Drug effects
B) Allergies
C) Pregnancy
D) Preexisting conditions
Ans: A
Feedback:
After the medication is administered, the nurse assesses the patient for drug affects, both
therapeutic and adverse. The nurse would assess the patient for allergies, preexisting conditions,
and pregnancy before administering a medication.

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14.
The nurse receives an order to administer an unfamiliar medication and obtains a nurses drug
guide published four years earlier. What is the nurses most prudent action?
A) Find a more recent reference source.
B) Use the guide if the drug is listed.
C) Ask another nurse for drug information.
D) Verify the information in the guide with the pharmacist.
Ans: A
Feedback:
The nurse is responsible for all medications administered and must find a recent reference
source to ensure the information learned about the medication is correct and current. Using an
older drug guide could be dangerous because it would not contain the most up-to-date
information. Asking another nurse or the pharmacist does not guarantee accurate information
will be obtained and could harm the patient if the information is wrong.
15.
What would the nurse provide when preparing a patient for discharge and home medication self-
administration?
A) Personal contact information to use if the patient has questions
B) Thorough medication teaching about drugs and the drug regimen
C) Over-the-counter medications to use to treat potential adverse effects
D) A sample size package of medication to take home until prescription is filled
Ans: B
Feedback:
The nurse is responsible for providing thorough medication teaching about drugs and the drug
regimen to ensure the patient knows how to take the medication and when to notify the provider.
The nurse never provides personal contact information to a patient. If adverse effects arise, the

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patient is taught to call the health care provider and should not self-medicate with over-the-
counter drugs, which could mask serious symptoms. The nurse never dispenses medication
because it must be properly labeled for home use; this is done by the pharmacy.
16.
In response to the patients question about how to know whether drugs are safe, the nurse
explains that all medications undergo rigorous scientific testing controlled by what
organization?
A) Food and Drug Administration (FDA)
B) Drug Enforcement Agency (DEA)
C) Centers for Disease Control and Prevention (CDC)
D) Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
Ans: A
Feedback:
The FDA is responsible for controlling and regulating the development and sale of drugs in the
United States, allowing new drugs to enter the market only after being subjected to rigorous
scientific testing. The DEA regulates and controls the use of controlled substances. The CDC
monitors and responds to infectious diseases. The JCAHO is an accrediting body that inspects
acute care facilities to ensure minimum standards are met.
17.
The nurse, assisting with Phase I drug studies, is talking with a woman who asks, Why cant I
participate in this study? What would be the nurses best response?
A) Drugs pose a greater risk to women of reproductive age.
B) Drugs are only tested on men because they are stronger.
C) Women are more prone to adverse effects from medications.
D) Drugs affect women differently than they affect women.
Ans: A

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Feedback:
Phase I drug trials usually involve healthy male volunteers because chemicals may exert an
unknown and harmful effect on ova in women which could result in fetal damage when the
woman becomes pregnant. Drugs are tested on both men and women, but women must be fully
informed of risks and sign a consent stating they understand the potential for birth defects.
Women are not more prone to adverse effects of medications. Although some drugs may affect
women differently than men, this is a rationale for why drugs need to be tested on women, not
an explanation of why women are not included in a phase I study.
18.
The patient tells the nurse about a new drug being tested to treat the disease she was diagnosed
with and asks the nurse whether the doctor can prescribe a medication still in the preclinical
phase of testing. What is the nurses best response?
A)
The doctor would have to complete a great deal of paperwork to get approval to prescribe
that drug.
B)
Sometimes pharmaceutical companies are looking for volunteers to test a new drug and
the doctor could give them your name.
C)
Drugs in the preclinical phase of testing are only tested on animals and so would not be
available to you.
D)
Drugs in the preclinical phase of testing are given only to healthy young men and so
would not be available to you.
Ans: C
Feedback:
During the preclinical phase of testing drugs are tested on animals and are not available to
patients. In phase I, the drug is tested on volunteers who are usually healthy young men. It is
only in phase III studies that the drug is made available to prescribers who agree to closely
monitor patients getting the medication.

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19.
The nurse is caring for a patient who had a severe, acute, previously unseen adverse effect of a
drug in Phase III testing. The patient asks, After all the testing done on this drug, didnt they
know this adverse effect could occur? What is the nurses best response? (Select all that apply.)
A) Pharmaceutical companies sometimes underreport problems to make more money.
B)
Your response to this medication will be reported to the drug company and the Food and
Drug Administration (FDA).
C)
When a drug begins to be used by a large clinical market, new adverse effects may be
found.
D)
The pharmaceutical company weighs the benefits of the drug with the severity of adverse
effects.
E)
After a drug reaches phase III testing it is considered an accepted drug and will not be
recalled.
Ans: B, C
Feedback:
When a new and unexpected adverse effect occurs, especially one of a serious nature, it is
reported to the drug company who reports it to the FDA immediately. When a large number of
people begin using the drug in phase III studies, it is not unusual to identify adverse effects not
previously noted. It would be both unprofessional and inaccurate to imply that pharmaceutical
companies put profit ahead of patient concern because lawsuits would remove any potential
profit if a drug proves harmful. The FDA is responsible for weighing risk versus benefit in
deciding whether to allow the drug to move to the next phase of testing. Drugs found to have
serious adverse effects can be removed from the market at any time.
20.
The telephone triage nurse receives a call from a patient asking for a prescription for a narcotic
to manage his surgical pain. The nurse explains that narcotic prescriptions must be written and
cannot be called in to the pharmacy. The patient says, Why are narcotics so difficult to get a
prescription for? What is the nurses best response?

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A)
The Drug Enforcement Agency (DEA) determines the risk for addiction and the Food
and Drug Administration (FDA) enforces their control.
B) The increase in the number of drug addicts has made the rules stronger.
C)
The Centers for Disease Control and Prevention (CDC) regulates use of controlled
substances to reduce the risk of injury.
D) Controlled substances like narcotics are controlled by the FDA and the DEA.
Ans: D
Feedback:
Controlled substances are controlled by the FDA and the DEA: the DEA enforces control while
the FDA determines abuse potential. Regulations related to controlled substances have remained
strict and specific and have not been significantly impacted by substance abusers. The CDC is
not involved in control of narcotics and other controlled substances.
21.
The nurse explains the Drug Enforcement Agencys (DEAs) schedule of controlled substances to
the nursing assistant who asks, Do you ever get a prescription for Schedule I medications? What
is the nurses best response?
A) Schedule I medications have no medical use so they are not prescribed.
B) Schedule I medications have the lowest risk for abuse and do not require a prescription.
C) Schedule I medications are only prescribed in monitored units for patient safety.
D) Schedule I medications are found in antitussives and antidiarrheals sold over the counter.
Ans: A
Feedback:
Schedule I medications have no medical use and are never prescribed. Schedule V medications
have the lowest risk for abuse and are found mostly in antitussives and antidiarrheals but they
are not sold over the counter.

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22.
The nurse, working on the maternity unit, receives a call from a pregnant woman asking how
she can know whether a medication is safe to take while pregnant. What is the nurses best
response?
A) You can take any drug indicated as a Category A.
B) No medications should be taken during pregnancy.
C) Never take medication until you receive approval from your health care provider.
D) Most medications are safe but you need to weigh benefit against risk.
Ans: C
Feedback:
The best response to a pregnant woman asking about medication usage is to talk with her
obstetric practitioner because the best advice will come from someone who knows their health
and pregnancy history. While Category A drugs have no known risk, they may be
contraindicated by the womans health condition or pregnancy issues and many pregnant women
would not know what it means to be a Category A drug. Medications can be helpful during
pregnancy if taken safely and appropriately. Although risk benefit needs to be weighed, it
should occur with advice from the obstetric practitioner.
23.
A patient asks the nurse, What is a Drug Enforcement Agency (DEA) number? What is the
nurses best response?
A)
DEA Numbers are given to physicians and pharmacists when they register with the DEA
to prescribe and dispense controlled substances.
B)
Physicians must have a DEA number in order to prescribe any type of medication for
patients.
C)
DEA numbers are case numbers given when someone breaks the law involving a
controlled substance.

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D)
DEA numbers are contact numbers to talk with someone at the DEA when questions
arise about controlled substances.
Ans: A
Feedback:
All pharmacists and physicians must register with the DEA. They are given numbers that are
required before they can dispense or prescribe controlled substances. DEA numbers are only
needed when prescribing controlled substances. A DEA number is neither a case number nor a
phone number.
24. When moving to another state, what is the nurse responsible for becoming familiar with?
A) Local policies and procedures for controlled substance administration
B)
Local providers Drug Enforcement Agency (DEA) number for prescribing controlled
substances
C) The agency monitoring controlled substances in the new state
D) Board of Nursing regulations of controlled substances in the new state
Ans: A
Feedback:
The nurse needs to learn local policies and procedures for controlled substance administration
because they can vary with some local governments more rigorous than others. Nurses do not
memorize a providers DEA numbers. The DEA is a federal agency that monitors controlled
substances in all states. State boards of nursing do not regulate controlled substances but may
regulate how controlled substances are administered by nurses.
25.
The patient looks at the prescription provided by the doctor and asks the nurse whether he can
request a generic substitution. The nurse answers No when noting what on the prescription?
A) No refills

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B) DAW
C) Brand name used on prescription
D) Patient older than 65 years of age
Ans: B
Feedback:
DAW stands for dispense as written and means that the doctor does not want a generic
substituted for the prescribed medication. Requesting no refills does not preclude the
substitution of a generic medication. Even when the brand name is ordered, the pharmacist can
substitute a generic equivalent so long as the prescriber does not write DAW. Generic
substitutions are not impacted by the patients age.
26.
The patient asks the nurse why generic drugs would be used and voices concerns that only the
brand name product will be safe. What is the nurses best response?
A) Generic drugs are often less expensive.
B) Some quality control problems have been found with generic drugs.
C) Most generic drugs are very safe and can be cost effective as well.
D) Although initial cost is higher for a brand name it may cost less in the long run.
Ans: C
Feedback:
Most generic medications are completely safe and may be identical to the brand name drug
except generic medications are often less expensive, but this does not address the patients
concern about safety. Although some quality control issues have occurred in the past, this does
not address the patients concerns regarding safety or explain why generic drugs are prescribed
and used. Although some doctors believe initial cost is higher but will cost less over time, this
response also does not address the patients concerns.

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27.
While studying for the test, the nursing student encounters the following drug: papaverine
(Pavabid). What does the nursing student identify the name Pavabid as?
A) The generic name
B) The chemical name
C) The brand name
D) The chemical and generic name
Ans: C
Feedback:
Several clues indicate the brand name including capitalization of the first letter in the name and
in parentheses. Generic names are not capitalized; chemical names are descriptions of the
chemistry of the medication resulting in complicated names.
28.
The patient is prescribed a medication that was just placed in Phase IV study. The patient tells
the nurse, This medication is too expensive. Could the doctor order a generic form of this
medication? What is the nurses most accurate response?
A)
Medications are not produced in generic form until the patent expires, which normally
takes several years.
B)
You can request the generic form but the binder used may make the drug less effective
for this medication.
C)
The generic form of the medication would not be any less expensive because this is a
relatively new medication.
D)
Generic medications are lower quality drugs and that would mean you would not be
getting the best treatment available.
Ans: A
Feedback:

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When a new drug enters the market, it is given a time-limited patent; generic forms of the
medication cannot be produced until the patent expires. Because no generic version of this drug
will exist because it is so new, it is impossible to predict what binder will be used or what the
cost would be.
29.
The nurse learns that a drug needed by the patient is classified as an orphan drug and recognizes
what as a reason for this classification? (Select all that apply.)
A) The drug is rarely prescribed.
B) The drug has dangerous adverse effects.
C) The drug treats a rare disease.
D) The patent on the medication is still effective.
E) Production by a company that only manufactures drugs.
Ans: A, B, C
Feedback:
Drugs are classified as orphan drugs when they are not financially viable for a drug company to
produce either because of risk for lawsuits about adverse effects or because the drug is not
prescribed, which is often seen in rare diagnoses. Generic drugs are not produced until the
patent expires, but this has no impact on classifying a particular drug as an orphan drug. Generic
drugs are often produced by companies that only manufacture drugs without conducting
research, but this has no bearing on the classification of orphan drugs.
30.
While collecting a medication history, the patient admits to doubling the recommended dosage
of an over-the-counter (OTC) medication, saying Its harmless or they would require a
prescription. What is the nurses best response?
A) OTC drugs are serious medications and carry serious risks if not taken as directed.
B) Taking medications like that is careless and you could kill yourself doing it.
C) Sometimes you need to take more than the package directs to treat the symptoms.

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D) Did you notify your doctor of the increased dosage you were taking?
Ans: A
Feedback:
OTC drugs are no less a medication than prescription drugs and carry the same types of risks for
overdosage and toxicity if directions are not followed. Although increasing the dosage is
careless and dangerous, it is important to use the information as a teaching opportunity rather
than scolding the patient. Agreeing with the patient or asking her if she talked to the doctor
misses the teaching opportunity, which could be harmful for the patient.
31.
The patient asks the nurse, Is it safe to take over-the-counter (OTC) medications with
prescription medications? What is the nurses best response? (Select all that apply.)
A) OTC medications can interact with prescription medications.
B) It is important to tell your doctor all medications you take, including OTC.
C) OTC medications could mask or hide signs and symptoms of a disease.
D) You should avoid taking any OTC medication when taking prescription drugs.
E) Taking OTC medications can make your prescription medication more effective.
Ans: A, B, C
Feedback:
OTC medications can interact with prescription medications or other OTC so it is always
important to consult your pharmacist and provider for advice. To provide the most accurate
instruction, the health care provider must know all medications taken including dietary
supplements, OTC, and prescription. OTC medications could mask or hide symptoms of a
disease so it is always important to consult a physician if symptoms persist. OTC medications
are not prohibited when taking prescription drugs as long as no drug interaction occurs. How an
OTC will impact a prescription medication varies depending on the medications involved, so it
is incorrect to say it will make the prescription drug more effective.

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32.
Before administering a prescription medication, what information does the nurse find on the
drug label? (Select all that apply.)
A) Brand name
B) Generic name
C) Drug concentration
D) Expiration date
E) Adverse effects
Ans: A, B, C, D
Feedback:
Prescription drug labels will contain the brand name, generic name, drug concentration, and
expiration date. Adverse effects will not be listed on drug labels.
33.
The nurse is preparing a medication that is new to the market and cannot be found in the nurses
drug guide. Where can the nurse get the most reliable information about this medication?
A) Package insert
B) Another nurse
C) Drug manufacturer
D) Physician
Ans: A
Feedback:
The most reliable information about the drug can be found on the package insert supplied by the
manufacturer because it was prepared according to strict Food and Drug Administration (FDA)
regulations. Asking another nurse or the physician is not reliable and cannot be verified as
accurate. It would not be realistic to call the drug manufacturer for information.

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34. The nurse explains that what drug resource book is compiled from package inserts?
A) Nurses Drug Guide
B) Physiciass Desk Reference (PDR)
C) Drug Facts and Comparisons
D) AMA Drug Evaluations
Ans: B
Feedback:
The PDR is a compilation of information found on package inserts. The Nurses Drug
Guide uses more easily understood language and incorporates nursing considerations and patient
teaching points. Drug Facts and Comparisons includes cost comparison, often not found in
other drug resource guides. The AMA Drug Evaluations is far less biased than the PDR and
includes drugs still in the research stage of development.
1.
Chapter 2
Drugs do not metabolize the same way in all people. For what patient would a nurse expect to
assess for an alteration in drug metabolism?
A) A 35-year-old woman with cervical cancer
B) A 41-year-old man with kidney stones
C) A 50-year-old man with cirrhosis of the liver
D) A 62-year-old woman in acute renal failure
Ans: C
Feedback:

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The liver is the most important site of drug metabolism. If the liver is not functioning effectively,
as in patients with cirrhosis, drugs will not metabolize normally so that toxic levels could develop
unless dosage is reduced. A patient with cervical cancer or kidney stones would not be expected
to have altered ability to metabolize drugs so long as no liver damage existed. The patient with
renal failure would have altered excretion of the drugs through the renal system but metabolism
would not be impacted.
2.
A patient presents to the emergency department with a drug level of 50 units/mL. The half-life of
this drug is 1 hour. With this drug, concentrations above 25 units/mL are considered toxic and no
more drug is given. How long will it take for the blood level to reach the non-toxic range?
A) 30 minutes
B) 1 hour
C) 2 hours
D) 3 hours
Ans: B
Feedback:
Half-life is the time required for the serum concentration of a drug to decrease by 50%. After 1
hour, the serum concentration would be 25 units/mL (50/2) if the body can properly metabolize
and excrete the drug. After 2 hours, the serum concentration would be 12.5 units/mL (25/2) and
reach the nontoxic range. In 30 minutes the drug level would be 37.5 units/mL, whereas in 3
hours the drug level would be 6.25.
3.
A patient has recently moved from Vermont to Southern Florida. The patient presents to the clinic
complaining of dizzy spells and weakness. While conducting the admission assessment, the
patient tells the nurse that he have been on the same antihypertensive drug for 6 years and had
stable blood pressures and no adverse effects. Since his move, he has been having problems and
he feels that the drug is no longer effective. The clinic nurse knows that one possible reason for
the change in the effectiveness of the drug could be what?

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A) The impact of the placebo effect on the patients response.
B) The accumulative effect of the drug if it has been taken for many years.
C) The impact of the warmer environment on the patients physical status.
D) Problems with patient compliance with the drug regimen while on vacation.
Ans: C
Feedback:
Antihypertensive drugs work to decrease the blood pressure. When a patient goes to a climate that
is much warmer than usual, blood vessels dilate and the blood pressure falls. If a patient is taking
an antihypertensive drug and moves to a warmer climate, there is a chance that the patients blood
pressure will drop too low, resulting in dizziness and feelings of weakness. Even mild
dehydration could exacerbate these effects. Most antihypertensives are metabolized and excreted
and do not accumulate in the body. Patients must be very compliant with their drug regimen on
vacation. After several years on an antihypertensive drug, the effects of that drug are known;
therefore, the placebo effect should not be an issue.
4.
An important concept taught by the nurse when providing medication teaching is the need to
provide a complete list of medications taken to health care providers to avoid what?
A) Spending large amounts of money on medications
B) Allergic reactions to medications
C) Drugdrug interactions
D) Critical concentrations of medications in the body
Ans: C
Feedback:
It is important that all health care providers have a complete list of the patients medications to
avoid drugdrug interactions caused by one provider ordering a medication, unaware of another

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medication the patient is taking that could interact with the new prescription. Using the same
pharmacist for all prescriptions will also help to prevent this from happening. Informing the
provider of all medications taken will not reduce costs of medications, which is best
accomplished by requesting generic medications. Allergies should be disclosed to all health care
providers as well, but this is not why it is important to provide a complete list of medications
taken. Critical concentrations are desirable because that is the amount of drug needed to cause a
therapeutic effect, or, in other words, to have the effect the drug is prescribed for.
5.
A pharmacology student asks the instructor what an accurate description of a drug agonist is.
What is the instructors best response?
A)
A drug that reacts with a receptor site on a cell preventing a reaction with another
chemical on a different receptor site
B)
A drug that interferes with the enzyme systems that act as catalyst for different chemical
reactions
C)
A drug that interacts directly with receptor sites to cause the same activity that a natural
chemical would cause at that site
D) A drug that reacts with receptor sites to block normal stimulation, producing no effect
Ans: C
Feedback:
Agonists are drugs that produce effects similar to those produced by naturally occurring
neurotransmitters, hormones, or other substances found in the body. Noncompetitive antagonists
are drugs that react with some receptor sites preventing the reaction of another chemical with a
different receptor site. Drugenzyme interactions interfere with the enzyme systems that stimulate
various chemical reactions.
6.
A nurse is caring for a patient who has been receiving a drug by the intramuscular route but will
receive the drug orally after discharge. How does the nurse explain the increased dosage
prescribed for the oral dose?

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A) Passive diffusion
B) Active transport
C) Glomerular filtration
D) First-pass effect
Ans: D
Feedback:
The first-pass effect involves drugs that are absorbed from the small intestine directly into the
portal venous system, which delivers the drug molecules to the liver. After reaching the liver,
enzymes break the drug into metabolites, which may become active or may be deactivated and
readily excreted from the body. A large percentage of the oral dose is usually destroyed and never
reaches tissues. Oral dosages account for the phenomenon to ensure an appropriate amount of the
drug in the body to produce a therapeutic action. Passive diffusion is the major process through
which drugs are absorbed into the body. Active transport is a process that uses energy to actively
move a molecule across a cell membrane and is often involved in drug excretion in the kidney.
Glomerular filtration is the passage of water and water-soluble components from the plasma into
the renal tubule.
7.
A nurse is working as a member of a research team involved in exploring the unique response to
drugs each individual displays based on genetic make-up. What is this area of study is called?
A) Pharmacotherapeutics
B) Pharmacodynamics
C) Pharmacoeconomics
D) Pharmacogenomics
Ans: D
Feedback:

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Pharmacogenomics is the area of study that includes mapping of the human genome. In the
future, medical care and drug regimens may be personally designed based on a patients unique
genetic make-up. Pharmacotherapeutics is the branch of pharmacology that deals with the uses of
drugs to treat, prevent, and diagnose disease. Pharmacodynamics involves how a drug affects the
body. Pharmacoeconomics includes the costs involved in drug therapy.
8. The nurse uses what term to describe the drug level required to have a therapeutic effect?
A) Critical concentration
B) Dynamic equilibrium
C) Selective toxicity
D) Active transport
Ans: A
Feedback:
A critical concentration of a drug must be present before a reaction occurs within the cells to
bring about the desired therapeutic effect. A dynamic equilibrium is obtained from absorption of
a drug from the site of drug entry, distribution to the active site, metabolism in the liver, and
excretion from the body to have a critical concentration. Selective toxicity is the ability of a drug
to attach only to those systems found in foreign cells. Active transport is the process that uses
energy to actively move a molecule across a cell membrane and is often involved in drug
excretion in the kidney.
9.
A nurse is caring for a patient who is supposed to receive two drugs at the same time. What is the
nurses priority action?
A) Wash her hands before handling the medications.
B) Consult a drug guide for compatibility.
C) Question the patient concerning drug allergies.
D) Identify the patient by checking the armband and asking the patient to state his name.

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Ans: B
Feedback:
A nurse should first consult a drug guide for compatibility when two or more drugs are being
given at the same time. After compatibility is determined the medication can be administered.
The nurse will perform hand hygiene, check for patient allergies, and ensure the right patient
receives the medication by using two identifiers.
10.
The nurse is talking with a group of nursing students who are doing clinical hours on the unit. A
student asks if all intramuscular (IM) drugs are absorbed the same. What factor would the floor
nurse tell the students to affect absorption of the IM administration of drugs?
A) Perfusion of blood to the subcutaneous tissue
B) Integrity of the mucous membranes
C) Environmental temperature
D) Blood flow to the gastrointestinal tract
Ans: C
Feedback:
A cold environmental temperature can cause blood vessels to vasoconstrict and decreases
absorption or in a hot environment vasodilate and increase absorption of IM medications. Blood
flow to the subcutaneous tissues interferes with subcutaneous injection and blood flow to the
gastrointestinal (GI) tract causes alterations in absorption for oral medications. The condition of
mucous membranes can interfere with sublingual (under the tongue) and buccal (in the cheek)
administration of drugs.
11.
The patient is taking a drug that affects the body by increasing cellular activity. Where does this
drug work on the cell?
A) Receptor sites
B) Cell membrane

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C) Golgi body
D) Endoplasmic reticulum
Ans: A
Feedback:
Many drugs are thought to act at specific areas on cell membranes called receptor sites. After
the receptor site is activated, this in turn activates the enzyme systems to produce certain effects,
such as increased or decreased cellular activity, changes in cell membrane permeability, or
alterations in cellular metabolism. Receptor sites are generally located on the outside of cells
and allow the drug to bypass the cell membrane. The Golgi body and endoplasmic reticulum are
not involved in this process.
12.
Several processes enable a drug to reach a specific concentration in the body. Together they are
called dynamic equilibrium. What are these processes? (Select all that apply.)
A) Distribution to the active site
B) Biotransformation
C) Absorption from the muscle
D) Excretion
E) Interaction with other drugs
Ans: A, B, D
Feedback:
The actual concentration that a drug reaches in the body results from a dynamic equilibrium
involving several processes: Absorption from the site of entry (can be from the muscle, the
gastrointestinal (GI) tract if taken orally, of the subcutaneous tissue if given by that route);
Distribution to the active site; biotransformation (metabolism) in the liver; excretion from the
body. Interaction with other drugs is not part of the dynamic equilibrium.

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13.
A nurse is administering digoxin to a patient. To administer medications so that the drug is as
effective as possible, the nurse needs to consider what?
A) Pharmacotherapeutics
B) Pharmacokinetics
C) Pharmacoeconomics
D) Pharmacogenomics
Ans: B
Feedback:
When administering a drug, the nurse needs to consider the phases of pharmacokinetics so that
the drug regimen can be made as effective as possible. Pharmacogenomics is the area of study
that includes mapping of the human genome. Pharmacotherapeutics is the branch of
pharmacology that deals with the uses of drugs to treat, prevent, and diagnose disease.
Pharmacoeconomics includes all costs involved in drug therapy.
14.
The nurse is explaining how medications work to a group of peers and explains that disruption
of a single step in any enzyme system disrupts what?
A) Cell life
B) Cell membrane
C) Cell receptor sites
D) Cell function
Ans: D
Feedback:
If a single step in one of the many enzyme systems is blocked, normal cell function is disrupted.
Cell life and cell membrane may be impacted by disruption of some enzymes but not all

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enzymes. Receptor sites would not be disrupted by disruption in a single step in the enzyme
system.
15.
The processes involved in dynamic equilibrium are key elements in the nurses ability to
determine what?
A) Dosage scheduling
B) Amount of solution for mixing parenteral drugs
C) Timing of other drugs the patient is taking
D) How long the patient has to take the drug
Ans: A
Feedback:
These processes are key elements in determining the amount of drug (dose) and the frequency of
dose repetition (scheduling) required to achieve the critical concentration for the desired length
of time. The processes in dynamic equilibrium are not key elements in determining the amount
of diluents for intramuscular (IM) drugs; they do not aid in the timing of the other drugs the
patient is taking or how long the patient has to take the drug.
16. What factor influences drug absorption?
A) Kidney function
B) Route of administration
C) Liver function
D) Cardiovascular function
Ans: B
Feedback:

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Focus on Nursing Pharmacology Seventh, North American Edition Test Bank

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