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?
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 (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	

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	
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	
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 nothing; this is a subnormal level of medication.	

ANS:	B
The therapeutic range for valproic acid is 50 to 100 mcg/mL.

DIF:	Cognitive Level: Analysis	REF:	p. 10	
TOP:	Nursing Process: Analysis	
MSC:	CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

	22.	The nurse is caring for a client who needs to have a peak drug level drawn. He was given the oral medication 30 minutes ago. What is the best action on the part of the nurse?
a.	Call the lab to have the medication level drawn immediately.	
b.	Arrange for the level to be drawn tomorrow since the peak time has passed.	
c.	Wait for at least another 30 minutes before calling to have the level drawn.	
d.	Schedule the level to be drawn in 8 hours.	

ANS:	C
The peak drug level for an oral drug can be 1 to 3 hours after drug administration.

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