Pharmacology: A Patient-Centered Nursing Process Approach, (Kee, Pharmacology) 8th Edition Test Bank

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Chapter 1: Drug Action:
Pharmaceutic,
Pharmacokinetic, and
Pharmacodynamic Phases
Kee: Pharmacology, 7th Edition
Chapter 1: Drug Action: Pharmaceutic, Pharmacokinetic, and
Pharmacodynamic Phases
Test Bank
MULTIPLE CHOICE
1. A nurse is providing an oral medication for pain relief to a client. To attain the
fastest pain relief, the nurse administers the medication so that it is most rapidly
absorbed from the gastrointestinal (GI) tract. Which mode of delivery has the fastest
absorption?
a. Tablet
b. Enteric-coated pill
c. Capsule
d. Liquid suspension
ANS: D
Drugs must be in solution to be absorbed in the gastrointestinal tract. Because liquid
drugs are already in solution, they are absorbed faster than drugs in a solid form.
DIF: Cognitive Level: Application REF: p. 3
TOP: Nursing Process: Intervention/Implementation
MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and
Parenteral Therapies
2. A client asks why she needs to take a medication on an empty stomach. The nurse
explains that food generally has which effect on drug dissolution and absorption?
a. Enhances
b. Increases
c. Decreases

d. Does not have an effect
ANS: C
Food in the GI tract can interfere with the dissolution and absorption of some drugs.
However, there are specific drugs that should be taken with food to enhance
absorption.
DIF: Cognitive Level: Application REF: p. 4
TOP: Nursing Process: Intervention/Teaching
MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and
Parenteral Therapies
3. Biotransformation is affected by many factors. What happens to the client’s drug
metabolism when liver function is decreased?
a. The client can develop toxicity.
b. The client will have an enhanced therapeutic response.
c. The client may require a larger than normal dose of the medication.
d. The client will experience a decreased therapeutic response.
ANS: A
When the drug metabolism rate is decreased, excess drug accumulation can occur and
lead to the client’s developing toxicity. The GI membrane is made up of lipids;
therefore, lipid medications are most easily absorbed across the digestive membrane
of the stomach. Medications that are nonionized (neither positive nor negative) also
pass through the GI membrane faster than those with a charge.
DIF: Cognitive Level: Application REF: p. 6
TOP: Nursing Process: Analysis
MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and
Parenteral Therapies
4. A client asks why the oral dose of her pain medication is higher than the
intravenous dose. The nurse explains that with the oral dose, only 20% to 40% of the
drug may actually enter systemic circulation. This reduces the amount of active drug.
What is the term for this effect?
a. Protein binding
b. Bioavailability
c. Hepatic first pass

d. Pinocytosis
ANS: B
Bioavailability is the percentage of the administered drug dose that reaches the
systemic circulation. Oral drugs that have a high first-pass hepatic metabolism may
have a bioavailability of only 20% to 40% on entering systemic circulation. To obtain
the desired drug effect, the oral dose could be three to five times larger than the drug
dose for IV use.
DIF: Cognitive Level: Comprehension REF: p. 4
TOP: Nursing Process: Analysis
MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and
Parenteral Therapies
5. When providing a medication, which route should the nurse select to ensure the
maximum amount of bioavailability?
a. Oral
b. Intravenous
c. Intramuscular
d. Subcutaneous
ANS: B
The percentage of bioavailability for the oral route is always less than 100%, but for
the intravenous route it is usually 100%.
DIF: Cognitive Level: Comprehension REF: p. 4
TOP: Nursing Process: Analysis
MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and
Parenteral Therapies
6. A client is being given two highly protein-bound drugs concurrently. What is most
likely to be the result of this administration?
a. More free drug in circulation
b. Less free drug in circulation
c. More drug bound to protein
d. More drug excreted in the urine
ANS: A

When two highly protein-bound drugs are given concurrently, they compete for
protein-binding sites, causing more free drug to be released into the circulation. Drug
accumulation and possible drug toxicity can result.
DIF: Cognitive Level: Application REF: p. 5
TOP: Nursing Process: Analysis
MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and
Parenteral Therapies
7. A client is taking a drug that is moderately highly protein bound. Several days later,
the client takes a second drug that is 90% protein bound. What is most likely to have
occurred as a result of this administration?
a. The first drug remains protein bound.
b. The first drug becomes increasingly inactive.
c. The first drug is released from the protein and becomes more pharmacologically active.
d. The second drug becomes more active.
ANS: C
Only drugs not bound to protein are active and can cause a pharmacologic response.
As the free drug in the circulation decreases, more bound drug is released from the
protein to maintain the balance of free drug.
DIF: Cognitive Level: Application REF: p. 5
TOP: Nursing Process: Active
MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and
Parenteral Therapies
8. A nurse is determining whether a medication is ordered to be given at the
appropriate intervals. This is done by assessing the half-life of the medication. The
serum half-life (t ) of a drug is the time required:
a. for half of a drug dose to be absorbed.
b. after absorption for half of the drug to be eliminated.
c. for a drug to be achieve maximum effectiveness.
d. for half of the drug dose to be completely distributed.
ANS: B
The half-life (t ) of a drug is the time it takes for one half of the drug concentration
to be eliminated.

DIF: Cognitive Level: Comprehension REF: pp. 5-6
TOP: Nursing Process: Analysis
MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and
Parenteral Therapies
9. A client is to receive a drug that has a half-life of 36 hours. The drug would
probably be administered on which dose schedule?
a. Once a week
b. Once a day
c. Twice a day
d. Three times a day
ANS: B
Since the medication requires 36 hours to be eliminated from the body, a once-daily
dosing pattern would allow therapeutic drug levels to be maintained.
DIF: Cognitive Level: Analysis REF: pp. 5-6
TOP: Nursing Process: Analysis
MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and
Parenteral Therapies
10. A client is suffering from end-stage renal disease. Because of this condition, the
nurse monitors drug levels to assess for which phenomenon?
a. Toxicity
b. Subtherapeutic levels
c. Drug ineffectiveness
d. Poor compliance
ANS: A
The primary route for drug elimination is the renal system. If kidney function is
impaired, drugs may reach toxic levels.
DIF: Cognitive Level: Comprehension REF: pp. 6-7
TOP: Nursing Process: Analysis
MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and
Parenteral Therapies
11. A client’s creatinine clearance level is 105 mL/min. Based on this information,
what type of change in his medication should the nurse anticipate?

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a. Increased dosage
b. Decreased dosage
c. Unchanged dosage
d. Dosage withheld
ANS: C
This is a normal creatinine clearance level (normal level is 85 to 135 mL/min);
therefore the dose would be unchanged.
DIF: Cognitive Level: Analysis REF: pp. 6-7
TOP: Nursing Process: Analysis
MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and
Parenteral Therapies
12. Isoproterenol (Isuprel) is an example of a medication that enhances the beta
receptors in the body. What is the term for drugs that stimulate a response?
a. Antagonists
b. Agonists
c. Depressants
d. Therapeutic effect
ANS: B
An agonist is a drug that produces a response.
DIF: Cognitive Level: Comprehension REF: p. 8
TOP: Nursing Process: Analysis
MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and
Parenteral Therapies
13. A nursing role is to teach clients to watch for adverse medication reactions. The
client should be able to recognize what about adverse reactions?
a. They are mild, easily treatable side effects.
b. They are therapeutic, expected effects.
c. They are undesired effects that may be severe.
d. They are the desired therapeutic effects.
ANS: C
Adverse reactions are a range of untoward effects (unintended and occurring at
normal doses) of drugs that cause mild-to-severe side effects, including anaphylaxis

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(cardiovascular collapse). Adverse reactions are always undesirable and must always
be reported and documented because they represent variances from planned therapy.
DIF: Cognitive Level: Comprehension REF: p. 10
TOP: Nursing Process: Analysis
MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and
Parenteral Therapies
14. The nurse teaches the client that undesired effects are frequently associated with a
client stopping a medication before completion of the full course. The nurse should
also instruct the client that physiologic effects not related to the desired effect, which
can be predicted or associated with the use of the drug, may also occur. What should
the client recognize about these physiologic effects?
a. They are severe adverse reactions.
b. They are side effects.
c. They are synergistic effects.
d. They are toxic effects.
ANS: B
Some side effects are expected as part of drug therapy. The occurrence of these
expected but undesirable side effects is not a reason to discontinue therapy. The
nurse’s role includes teaching clients to report any side effects. It is important to know
that the occurrence of side effects is one of the primary reasons clients stop taking the
prescribed medication.
DIF: Cognitive Level: Application REF: p. 10
TOP: Nursing Process: Analysis
MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and
Parenteral Therapies
15. A nurse is learning how to draw peak and trough levels of a medication. In order
to draw them correctly, the nurse should know what the trough level is. The trough
level is the __________ of a drug.
a. minimum effective concentration
b. highest plasma concentration
c. lowest plasma concentration
d. rate of absorption

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ANS: C
The trough drug level is the lowest plasma concentration of a drug, and it measures
the rate at which the drug is eliminated.
DIF: Cognitive Level: Comprehension REF: p. 9
TOP: Nursing Process: Analysis
MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and
Parenteral Therapies
16. The client is receiving frequent daily drug dosing of a drug that has a long
duration of action. What should the nurse expect to be the result of this
administration?
a. Drug accumulation and possible drug toxicity
b. Increased drug excretion
c. Enhanced therapeutic response
d. Increased drug half-life
ANS: A
When the drug level exceeds the therapeutic range, toxic effects are likely to occur
from overdosing or drug accumulation. Medications with a long half-life and frequent
dosing may build up in the system or accumulate and lead to toxic effects.
DIF: Cognitive Level: Analysis REF: p. 10
TOP: Nursing Process: Analysis
MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and
Parenteral Therapies
17. The nurse notes that the client is rapidly developing a decreased response to a
medication. This decreased response is known as:
a. pharmacogenetics.
b. tachyphylaxis.
c. drug accumulation.
d. drug toxicity.
ANS: B
Tachyphylaxis refers to a rapid decrease in response to the drug.
DIF: Cognitive Level: Comprehension REF: p. 11
TOP: Nursing Process: Analysis

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MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and
Parenteral Therapies
18. Because of hereditary influence, drug action may vary from a predicted drug
response. This variance is known as:
a. biotransformation.
b. tachyphylaxis.
c. pharmacogenetics.
d. transcription factors.
ANS: C
Pharmacogenetics is the effect of a drug action that varies from a predicted drug
response because of genetic factors or hereditary influence.
DIF: Cognitive Level: Comprehension REF: p. 11
TOP: Nursing Process: Analysis
MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and
Parenteral Therapies
19. The nurse is monitoring a patient prescribed an aminoglycoside antibiotic for
toxicity. Which nursing intervention is indicated when administering this medication?
a. Ensure that the client voids before administration.
b. Have emergency airway equipment at the bedside.
c. Monitor blood levels of the medication.
d. Determine liver function before each dose.
ANS: C
For those drugs with a narrow therapeutic index, such as aminoglycoside antibiotics
and anticonvulsants, the therapeutic ranges are closely monitored.
DIF: Cognitive Level: Analysis REF: p. 10
TOP: Nursing Process: Planning
MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and
Parenteral Therapies
20. The nurse sees that the client has been prescribed a loading dose of medication.
What effect should the nurse expect to result from the client receiving a loading dose?
a. A rapid maximum effective concentration
b. Maintenance dose the lowest plasma concentration of the drug

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c. Therapeutic dose the highest plasma concentration of the drug
d. A rapid minimum effective concentration
ANS: D
When immediate drug response is desired, a large initial dose, known as the loading
dose, of drug is given to achieve a rapid minimum effective concentration in the
plasma. After a large initial dose, a prescribed dosage per day is ordered.
DIF: Cognitive Level: Analysis REF: pp. 9-1
TOP: Nursing Process: Analysis
MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and
Parenteral Therapies
21. The nurse receives the results of laboratory testing and sees that the level of
valproic acid in the client’s blood is 78 mcg/mL. What is the nurse’s most appropriate
response?
a. The nurse must call the physician immediately; this is a toxic level of medication.
b. He or she must do nothing; this is a therapeutic level of medication.
c. He or she must call the physician; this is a dangerously high level of medication.
d. The nurse must do

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DIF: Cognitive Level: Application REF: p. 9
TOP: Nursing Process: Planning
MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and
Parenteral Therapies
23. The client has been prescribed digoxin. Before administering the drug on a routine
basis to the client, the nurse should recognize that the client should receive a _____
dose.
a. therapeutic
b. peak
c. trough
d. loading
ANS: D
Digoxin requires a loading dose when first prescribed.
DIF: Cognitive Level: Application REF: pp. 9-10
TOP: Nursing Process: Planning
MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and
Parenteral Therapies
24. The client has been placed on an enteric-coated medication. An appropriate action
on the part of the nurse is to instruct the client to __________ the medication.
a. weigh herself at the same time every day while on
b. drink at least eight glasses of water daily while on
c. adhere to a low-sodium diet while on
d. avoid eating fatty food before taking
ANS: D
Fatty foods decrease the absorption rate of enteric-coated tablets.
DIF: Cognitive Level: Application REF: pp. 11-12
TOP: Nursing Process: Planning
MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and
Parenteral Therapies

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Kee: Pharmacology, 7th Edition
Chapter 2: Nursing Process and Client Teaching
Test Bank
MULTIPLE CHOICE
1. Which is the sequence of steps in the nursing process?
a. Implementation, evaluation, planning, assessment
b. Planning, assessment, implementation, evaluation
c. Assessment, planning, implementation, evaluation
d. Evaluation, implementation, assessment, planning
ANS: C
The four phases of the nursing process are assessment, planning, implementation, and
evaluation.
DIF: Cognitive Level: Comprehension REF: pp. 14-15

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The effectiveness of health teaching about drug therapy and the attainment of goals
are associated with evaluation.
DIF: Cognitive Level: Comprehension REF: pp. 19-20
TOP: Nursing Process: Evaluation
MSC: CONTENT CATEGORY: Management of Care
4. During which phase of the nursing process would the nurse identify client
perceptions and expectations of the drug’s effectiveness?
a. Planning
b. Assessment
c. Evaluation
d. Implementation
ANS: B
This information consists of subjective data.
DIF: Cognitive Level: Comprehension REF: p. 15
TOP: Nursing Process: Assessment
MSC: CONTENT CATEGORY: Management of Care
5. The nurse is establishing goals for a client related to medication administration.
Which of the phases of the nursing process is characterized by goal setting?
a. Planning
b. Evaluation
c. Implementation
d. Assessment
ANS: A
The planning phase of the nursing process is characterized by goal setting or expected
outcomes.
DIF: Cognitive Level: Comprehension REF: p. 16
TOP: Nursing Process: Planning
MSC: CONTENT CATEGORY: Management of Care
6. During which phase of the nursing process will the nurse include nursing actions or
interventions necessary to accomplish expected outcomes?
a. Assessment
b. Planning

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c. Implementation
d. Evaluation
ANS: C
The implementation phase of the nursing process includes the nursing
actions/interventions necessary to accomplish the established goals or expected
outcomes.
DIF: Cognitive Level: Comprehension REF: pp. 16-19
TOP: Nursing Process: Implementation
MSC: CONTENT CATEGORY: Management of Care
7. Which is a correctly written goal?
a.
The client will independently administer a prescribed dose of antibiotic by the end of the fir
teaching session.
b. The client will

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11. A nurse is teaching a client about a medication that is scheduled to be
administered q.i.d. The client states that she does not use a watch or clock and lives
without a daily routine. Which teaching would be most helpful for the client?
a. Instruct the client to take the medication each morning and evening when brushing her teeth
b. Teach the client to take the medication at lunch every day.
c. Provide the client with a watch to ensure she

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c. Provide a teaching sheet with simple words and pictures.
d. Arrange a quiet time to discuss the medication regimen with the client.
ANS: D
This strategy takes both the client’s strengths and cultural factors into account.
DIF: Cognitive Level: Application REF: pp. 17-19
TOP: Nursing Process: Planning
MSC: CONTENT CATEGORY: Management of Care
14. A client with AIDS-defined disease is ordered to receive two different
medications. The primary care nurse notes that he has not been taking his medications
as ordered. The client says, “I don’t like the side effects of the drugs.” Which is an
appropriate nursing diagnosis?

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TOP: Nursing Process: Analysis
MSC: CONTENT CATEGORY: Management of Care
16. The nurse has decided to add a nursing diagnosis to the client’s drug therapy plan
of care that represents wellness/health promotion. What is the most appropriate
diagnosis to add to promote these areas?
a. Ineffective health maintenance related to not having recommended preventive care
b. Risk for injury related to side effect if drugs
c. Therapeutic regimen management, readiness for enhanced
d.

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2. “Give Tylenol 650 mg q3-4h as needed for headache” is an example of which
category of drug order?
a. Standing drug order
b. One-time drug order
c. PRN
d. STAT
ANS: C
PRN means to administer the drug on an as-needed basis.
DIF: Cognitive Level: Comprehension REF: p. 25
TOP: Nursing Process: Intervention/Implementation
MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and
Parenteral Therapies
3. A nurse is administering a medication to a client. The nurse tells the client the
rationale for the medication. This nurse is observing which client right?
a. The right

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Sublingual means under the tongue.
DIF: Cognitive Level: Comprehension REF: p. 26
TOP: Nursing Process: Intervention/Implementation
MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and
Parenteral Therapies
5. The nurse is calculating the dosage of a drug to administer. Once the dosage has
been calculated, what is the most important action on the part of the nurse?
a. Contact the pharmacist for dosage confirmation.
b. Check the identity of the patient three times.
c. Recalculate the drug dose and check with another nurse.
d. Check

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7. The nurse checks the expiration date on the medication to be administered and finds
that the drug expired 2 days ago. What is the most appropriate action on the part of the
nurse?
a. Hold one dose of the medication.
b. Return the medication to the pharmacy.
c. Contact the physician for orders.
d. Administer the drug but monitor the client.
ANS: B
When a medication is found to have expired, discard it or return it to the pharmacy.
DIF: Cognitive Level: Analysis REF: p. 25

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d. Accurately and completely reconcile medications across the continuum of care.
ANS: B
The use of standardized abbreviations fulfills the goal of improving the effectiveness
of communication among caregivers.
DIF: Cognitive Level: Analysis REF: pp. 27-29
TOP: Nursing Process: Intervention/Implementation
MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and
Parenteral Therapies
10. The nurse ensures that she provides the next nurse taking over the care of her
client with a complete list of his medications since the next nurse is newly admitted to
that unit. She recognizes that this fulfills which of the National Patient Safety Goals?
a. Improve the accuracy of patient identification
b. Improve the effectiveness of communication among caregivers
c.

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DIF: Cognitive Level: Analysis REF: p. 30
TOP: Nursing Process: Intervention/Implementation
MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and
Parenteral Therapies
12. The client has been on an oral dose of a medication. The nurse recognizes that the
client is experiencing difficulty swallowing. What is the most important action on the
nurse’s part?
a. Crush the medication and mix it with water.
b. Split the medication in half and mix it in jelly.
c. Call the physician for a liquid version of the

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14. The nurse is calculating a dosage of medication for an infant. The nurse
recognizes that the dosage is based on the infant’s:
a. biological age.
b. weight in pounds.
c. gestational age.
d. weight in kilograms.
ANS: D
Infant doses are calculated on the basis of weight in kilograms.
DIF: Cognitive Level: Application REF: p. 32
TOP: Nursing Process: Intervention/Implementation
MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and
Parenteral Therapies
15. The nurse is caring for a thin-framed adult who is scheduled to receive multiple
doses of antineoplastic medication. The nurse should expect the dosage for this person
to be:
a. lower than normal.

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MULTIPLE CHOICE
1. The nurse is preparing to administer an intramuscular injection to an infant. What is
the most accurate site for the nurse to select for this administration?
a. Ventrogluteal
b. Vastus lateralis
c. Dorsogluteal
d. Deltoid
ANS: B
The vastus lateralis is the most appropriate site to utilize for an IM injection in an
infant.
DIF: Cognitive Level: Comprehension REF: p. 44
TOP: Nursing Process: Intervention/Implementation
MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and
Parenteral Therapies
2. What is an appropriate nursing intervention to use to meet the psychiatric needs of a
hospitalized infant?
a. Move slowly while conducting care.

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d. Gently press on the lacrimal duct.
ANS: D
By applying pressure on the inner canthus of the eye, the medication is less likely to
be systemically absorbed.
DIF: Cognitive Level: Application REF: p. 37
TOP: Nursing Process: Intervention/Implementation
MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and
Parenteral Therapies
4. A nurse is preparing to administer a deep IM injection to a client. Which site is
suited for a deep IM injection?
a. Abdomen
b. Dorsogluteal
c. Deltoid
d. Vastus lateralis
ANS: B
The dorsogluteal site is suited for deep IM or Z-track injections.
DIF: Cognitive Level: Comprehension REF: p. 44

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