Chapter 4 My Nursing Test Banks

 

Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/E
Chapter 4

Question 1

Type: MCSA

The nurse is conducting medication education for patients with hypertension. The focus of the education is on enhancing the absorption of their medications. The nurse determines that learning has occurred when the patients make which statement?

1. We can safely take the drug for at least 6 months beyond the expiration date.

2. We dont need to worry about storage of the drug, it wont lose potency.

3. We should not take our medications with milk or dairy products.

4. We need to be careful about taking the medication with certain foods.

Correct Answer: 4

Rationale 1: Food can alter the absorption of many medications. Storage can affect the medications strength and may affect how it responds in the body. There are many more foods that will alter the absorption of medications other than milk and dairy products. Patients should be taught to avoid taking medications beyond the expiration date.

Rationale 2: Food can alter the absorption of many medications. Storage can affect the medications strength and may affect how it responds in the body. There are many more foods that will alter the absorption of medications other than milk and dairy products. Patients should be taught to avoid taking medications beyond the expiration date.

Rationale 3: Food can alter the absorption of many medications. Storage can affect the medications strength and may affect how it responds in the body. There are many more foods that will alter the absorption of medications other than milk and dairy products. Patients should be taught to avoid taking medications beyond the expiration date.

Rationale 4: Food can alter the absorption of many medications. Storage can affect the medications strength and may affect how it responds in the body. There are many more foods that will alter the absorption of medications other than milk and dairy products. Patients should be taught to avoid taking medications beyond the expiration date.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 4-1

Question 2

Type: MCSA

The physician ordered a loading dose of medication for the patient; it is to be followed by a lower dose. When the patient receives the lower dose, she says to the nurse, I think my doctor made a mistake; my medication dose is too low. What is the best response by the nurse?

1. The initial dose shortened the half-life, so the medication would work more quickly.

2. We always give medications this way; the doctor did not make a mistake.

3. You had a larger dose initially so that the medication would work more quickly.

4. Giving a larger dose initially will reduce the chance of side effects.

Correct Answer: 3

Rationale 1: Loading doses of medications are used to quickly induce a therapeutic response. Loading doses do not shorten the half-life of a drug. Not all medications are initiated with a loading dose. Loading doses do not reduce the occurrence of side effects.

Rationale 2: Loading doses of medications are used to quickly induce a therapeutic response. Loading doses do not shorten the half-life of a drug. Not all medications are initiated with a loading dose. Loading doses do not reduce the occurrence of side effects.

Rationale 3: Loading doses of medications are used to quickly induce a therapeutic response. Loading doses do not shorten the half-life of a drug. Not all medications are initiated with a loading dose. Loading doses do not reduce the occurrence of side effects.

Rationale 4: Loading doses of medications are used to quickly induce a therapeutic response. Loading doses do not shorten the half-life of a drug. Not all medications are initiated with a loading dose. Loading doses do not reduce the occurrence of side effects.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4-12

Question 3

Type: MCSA

The patient has meningitis. The physician initially prescribed a water-soluble drug. Another physician changed the order to a lipid-soluble drug. The patient is confused about this. Which plan best resolves the patients concern?

1. Teach the patient that lipid-soluble drugs are better because of protein binding.

2. Teach the patient that lipid-soluble drugs are more effective in treating his illness.

3. Teach the patient that lipid-soluble drugs are better because they have fewer side effects.

4. Teach the patient that lipid-soluble drugs are more effective because they are excreted at a slower rate.

Correct Answer: 2

Rationale 1: Drug molecules that are lipid soluble will usually pass through plasma membranes by simple diffusion and more easily reach their target cells. Lipid-soluble drugs do not necessarily have fewer side effects. Not all lipid-soluble drugs are protein bound. Lipid solubility does not affect drug excretion.

Rationale 2: Drug molecules that are lipid soluble will usually pass through plasma membranes by simple diffusion and more easily reach their target cells. Lipid-soluble drugs do not necessarily have fewer side effects. Not all lipid-soluble drugs are protein bound. Lipid solubility does not affect drug excretion.

Rationale 3: Drug molecules that are lipid soluble will usually pass through plasma membranes by simple diffusion and more easily reach their target cells. Lipid-soluble drugs do not necessarily have fewer side effects. Not all lipid-soluble drugs are protein bound. Lipid solubility does not affect drug excretion.

Rationale 4: Drug molecules that are lipid soluble will usually pass through plasma membranes by simple diffusion and more easily reach their target cells. Lipid-soluble drugs do not necessarily have fewer side effects. Not all lipid-soluble drugs are protein bound. Lipid solubility does not affect drug excretion.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 4-3

Question 4

Type: MCSA

The patient is malnourished and has a low serum albumin. The physician has ordered aspirin, a highly protein-bound drug, for the patient. Which evaluation by the nurse best describes the effect this will have on the patient?

1. The patient will be at risk to experience a decreased effectiveness of the drug.

2. The patient will be at risk to experience toxic effects of the drug.

3. The patients kidneys will excrete the drug at a faster rate.

4. The patients serum globulin is more important than serum albumin.

Correct Answer: 2

Rationale 1: Aspirin is a protein-bound drug. With a low albumin, there is less protein for aspirin to bind with, making more free drug available. There may be toxic, not decreased, effects from the drug because there is less protein for aspirin to bind with and more free drug available. The kidney will not be able to balance the amount of the drug and excrete it at a faster rate. Serum albumin plays a major role, more than serum globulin.

Rationale 2: Aspirin is a protein-bound drug. With a low albumin, there is less protein for aspirin to bind with, making more free drug available. There may be toxic, not decreased, effects from the drug because there is less protein for aspirin to bind with and more free drug available. The kidney will not be able to balance the amount of the drug and excrete it at a faster rate. Serum albumin plays a major role, more than serum globulin.

Rationale 3: Aspirin is a protein-bound drug. With a low albumin, there is less protein for aspirin to bind with, making more free drug available. There may be toxic, not decreased, effects from the drug because there is less protein for aspirin to bind with and more free drug available. The kidney will not be able to balance the amount of the drug and excrete it at a faster rate. Serum albumin plays a major role, more than serum globulin.

Rationale 4: Aspirin is a protein-bound drug. With a low albumin, there is less protein for aspirin to bind with, making more free drug available. There may be toxic, not decreased, effects from the drug because there is less protein for aspirin to bind with and more free drug available. The kidney will not be able to balance the amount of the drug and excrete it at a faster rate. Serum albumin plays a major role, more than serum globulin.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 4-7

Question 5

Type: MCSA

The patient is admitted to the hospital in chronic renal failure, and is on several medications. What best describes the nurses assessment of this patient?

1. The patients liver may compensate for renal failure; the drugs may be effective.

2. The patient may have drug toxicity from all the drugs.

3. The patient may have drug toxicity only if the drugs are excreted by the kidneys.

4. The patient may have decreased effectiveness of the drugs.

Correct Answer: 2

Rationale 1: Since the kidneys are the primary route of excretion for many drugs, chronic renal failure puts the patient at risk for drug toxicity. The patient in chronic renal failure will more likely have drug toxicity than decreased effectiveness of the drugs. The liver cannot compensate for renal failure; the patient is at risk for drug toxicity. Since the majority of drugs are excreted by the kidneys, the patient will most likely have drug toxicity.

Rationale 2: Since the kidneys are the primary route of excretion for many drugs, chronic renal failure puts the patient at risk for drug toxicity. The patient in chronic renal failure will more likely have drug toxicity than decreased effectiveness of the drugs. The liver cannot compensate for renal failure; the patient is at risk for drug toxicity. Since the majority of drugs are excreted by the kidneys, the patient will most likely have drug toxicity.

Rationale 3: Since the kidneys are the primary route of excretion for many drugs, chronic renal failure puts the patient at risk for drug toxicity. The patient in chronic renal failure will more likely have drug toxicity than decreased effectiveness of the drugs. The liver cannot compensate for renal failure; the patient is at risk for drug toxicity. Since the majority of drugs are excreted by the kidneys, the patient will most likely have drug toxicity.

Rationale 4: Since the kidneys are the primary route of excretion for many drugs, chronic renal failure puts the patient at risk for drug toxicity. The patient in chronic renal failure will more likely have drug toxicity than decreased effectiveness of the drugs. The liver cannot compensate for renal failure; the patient is at risk for drug toxicity. Since the majority of drugs are excreted by the kidneys, the patient will most likely have drug toxicity.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 4-8

Question 6

Type: MCSA

The patient comes to the emergency department following an overdose of aspirin, an acidic drug. What will the best plan of the nurse include?

1. Administration of intravenous fluids to flush the kidneys

2. Administration of ammonium chloride to the patient

3. Administration of sodium bicarbonate to the patient

4. Administration of intravenous proteins to bind the aspirin

Correct Answer: 3

Rationale 1: Sodium bicarbonate will alkalinize the urine and increase the excretion of aspirin from the body. Administering proteins will not help with the excretion of aspirin from the body. Administering intravenous (IV) fluids will not increase the excretion of aspirin from the body. Ammonium chloride will acidify the urine and cause reabsorption of the aspirin.

Rationale 2: Sodium bicarbonate will alkalinize the urine and increase the excretion of aspirin from the body. Administering proteins will not help with the excretion of aspirin from the body. Administering intravenous (IV) fluids will not increase the excretion of aspirin from the body. Ammonium chloride will acidify the urine and cause reabsorption of the aspirin.

Rationale 3: Sodium bicarbonate will alkalinize the urine and increase the excretion of aspirin from the body. Administering proteins will not help with the excretion of aspirin from the body. Administering intravenous (IV) fluids will not increase the excretion of aspirin from the body. Ammonium chloride will acidify the urine and cause reabsorption of the aspirin.

Rationale 4: Sodium bicarbonate will alkalinize the urine and increase the excretion of aspirin from the body. Administering proteins will not help with the excretion of aspirin from the body. Administering intravenous (IV) fluids will not increase the excretion of aspirin from the body. Ammonium chloride will acidify the urine and cause reabsorption of the aspirin.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 4-8

Question 7

Type: MCSA

The patient is complaining of a severe headache. The physician orders aspirin. Which action by the nurse will result in the fastest relief of the patients headache?

1. Administer the aspirin with an alkaline food, like cottage cheese.

2. Administer the aspirin in an enteric-coated formulation.

3. Administer the aspirin with a high-fat food, like peanut butter.

4. Administer the aspirin on an empty stomach.

Correct Answer: 4

Rationale 1: Acids such as aspirin are best absorbed in the acidic environment of the stomach, so the aspirin should be administered on an empty stomach. Administering the aspirin in an enteric-coated formulation will lessen gastrointestinal irritation, but will increase the time for the drugs effect. Peanut butter and cottage cheese will slow absorption and increase the time for the drugs effect.

Rationale 2: Acids such as aspirin are best absorbed in the acidic environment of the stomach, so the aspirin should be administered on an empty stomach. Administering the aspirin in an enteric-coated formulation will lessen gastrointestinal irritation, but will increase the time for the drugs effect. Peanut butter and cottage cheese will slow absorption and increase the time for the drugs effect.

Rationale 3: Acids such as aspirin are best absorbed in the acidic environment of the stomach, so the aspirin should be administered on an empty stomach. Administering the aspirin in an enteric-coated formulation will lessen gastrointestinal irritation, but will increase the time for the drugs effect. Peanut butter and cottage cheese will slow absorption and increase the time for the drugs effect.

Rationale 4: Acids such as aspirin are best absorbed in the acidic environment of the stomach, so the aspirin should be administered on an empty stomach. Administering the aspirin in an enteric-coated formulation will lessen gastrointestinal irritation, but will increase the time for the drugs effect. Peanut butter and cottage cheese will slow absorption and increase the time for the drugs effect.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4-4

Question 8

Type: MCSA

The patient is receiving lithium (Eskalith) and asks the nurse why he has to have blood drawn so often. What is the best response by the nurse?

1. To detect side effects before they become a problem.

2. To be sure the medication is working properly.

3. To determine if your body is responding as it should.

4. To be sure you have the correct amount of medication in your system.

Correct Answer: 4

Rationale 1: Medications, such as lithium (Eskalith), with a narrow therapeutic range must be monitored with lab tests; this is how the correct dosage is determined. A lab test will not confirm that the medication is working properly; assessment of the patient confirms this. Body response to the medication is best determined by patient assessment. Side effects are best determined by patient assessment.

Rationale 2: Medications, such as lithium (Eskalith), with a narrow therapeutic range must be monitored with lab tests; this is how the correct dosage is determined. A lab test will not confirm that the medication is working properly; assessment of the patient confirms this. Body response to the medication is best determined by patient assessment. Side effects are best determined by patient assessment.

Rationale 3: Medications, such as lithium (Eskalith), with a narrow therapeutic range must be monitored with lab tests; this is how the correct dosage is determined. A lab test will not confirm that the medication is working properly; assessment of the patient confirms this. Body response to the medication is best determined by patient assessment. Side effects are best determined by patient assessment.

Rationale 4: Medications, such as lithium (Eskalith), with a narrow therapeutic range must be monitored with lab tests; this is how the correct dosage is determined. A lab test will not confirm that the medication is working properly; assessment of the patient confirms this. Body response to the medication is best determined by patient assessment. Side effects are best determined by patient assessment.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4-11

Question 9

Type: MCSA

The nursing mother asks the nurse if it is all right to take St. Johns wort for mild depression. What is the best response by the nurse?

1. No, it will probably cause your baby to have more allergies.

2. No, because it might decrease the amount of milk you produce.

3. No, it could be excreted in your milk and affect the baby.

4. No, it will affect the taste of your milk, and your baby might reject nursing.

Correct Answer: 3

Rationale 1: Many drugs are excreted in breast milk and can affect the nursing infant. Taking St. Johns wort is not likely to cause the baby to have more allergies. Taking St. Johns wort is not likely to decrease the amount of milk the mother produces. Taking St. Johns wort may affect the taste of the mothers milk, but this is not the most important response.

Rationale 2: Many drugs are excreted in breast milk and can affect the nursing infant. Taking St. Johns wort is not likely to cause the baby to have more allergies. Taking St. Johns wort is not likely to decrease the amount of milk the mother produces. Taking St. Johns wort may affect the taste of the mothers milk, but this is not the most important response.

Rationale 3: Many drugs are excreted in breast milk and can affect the nursing infant. Taking St. Johns wort is not likely to cause the baby to have more allergies. Taking St. Johns wort is not likely to decrease the amount of milk the mother produces. Taking St. Johns wort may affect the taste of the mothers milk, but this is not the most important response.

Rationale 4: Many drugs are excreted in breast milk and can affect the nursing infant. Taking St. Johns wort is not likely to cause the baby to have more allergies. Taking St. Johns wort is not likely to decrease the amount of milk the mother produces. Taking St. Johns wort may affect the taste of the mothers milk, but this is not the most important response.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4-8

Question 10

Type: MCMA

The nursing instructor is teaching pharmacology to student nurses. What will the nursing instructor include as the four major components of pharmacokinetics?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. How drugs move from the site of administration to circulating fluids

2. How drugs are converted to a form that is easily removed from the body

3. How drugs change body illnesses and pathogens

4. How drugs are transported throughout the body

5. How drugs are removed from the body

Correct Answer: 1,2,4,5

Rationale 1: Absorption describes how drugs move from the site of administration to circulating fluids. Distribution describes how drugs are transported throughout the body. Metabolism describes how drugs are converted to a form that is easily removed from the body. Excretion describes how drugs are removed from the body. Pharmacodynamics describes how drugs change body illnesses and pathogens.

Rationale 2: Absorption describes how drugs move from the site of administration to circulating fluids. Distribution describes how drugs are transported throughout the body. Metabolism describes how drugs are converted to a form that is easily removed from the body. Excretion describes how drugs are removed from the body. Pharmacodynamics describes how drugs change body illnesses and pathogens.

Rationale 3: Absorption describes how drugs move from the site of administration to circulating fluids. Distribution describes how drugs are transported throughout the body. Metabolism describes how drugs are converted to a form that is easily removed from the body. Excretion describes how drugs are removed from the body. Pharmacodynamics describes how drugs change body illnesses and pathogens.

Rationale 4: Absorption describes how drugs move from the site of administration to circulating fluids. Distribution describes how drugs are transported throughout the body. Metabolism describes how drugs are converted to a form that is easily removed from the body. Excretion describes how drugs are removed from the body. Pharmacodynamics describes how drugs change body illnesses and pathogens.

Rationale 5: Absorption describes how drugs move from the site of administration to circulating fluids. Distribution describes how drugs are transported throughout the body. Metabolism describes how drugs are converted to a form that is easily removed from the body. Excretion describes how drugs are removed from the body. Pharmacodynamics describes how drugs change body illnesses and pathogens.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 4-2

Question 11

Type: MCSA

The patient is scheduled to receive a medication that is an enzyme inducer of the P450 system. What best describes the effect of this medication on the patient?

1. In time, the patient will experience no effect from other medications.

2. In time, the patient will experience increased effects from other medications.

3. In time, the patient will experience a reduced effect from this medication.

4. In time, the patient will experience an increased effect from this medication.

Correct Answer: 3

Rationale 1: An enzyme inducer will increase the rate of its own metabolism, thereby reducing its effectiveness. An enzyme inhibitor will result in an increased effect of this medication. An enzyme inhibitor will result in an increased effect from other medications. The patient will experience a reduced effect from other medications, not an absence of effect.

Rationale 2: An enzyme inducer will increase the rate of its own metabolism, thereby reducing its effectiveness. An enzyme inhibitor will result in an increased effect of this medication. An enzyme inhibitor will result in an increased effect from other medications. The patient will experience a reduced effect from other medications, not an absence of effect.

Rationale 3: An enzyme inducer will increase the rate of its own metabolism, thereby reducing its effectiveness. An enzyme inhibitor will result in an increased effect of this medication. An enzyme inhibitor will result in an increased effect from other medications. The patient will experience a reduced effect from other medications, not an absence of effect.

Rationale 4: An enzyme inducer will increase the rate of its own metabolism, thereby reducing its effectiveness. An enzyme inhibitor will result in an increased effect of this medication. An enzyme inhibitor will result in an increased effect from other medications. The patient will experience a reduced effect from other medications, not an absence of effect.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 4-5

Question 12

Type: MCMA

The patient tells the nurse that he is on many medications, and questions how they all get to the right places. What is the best response by the nurse?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. It depends on how much protein you have in your body.

2. It depends on the health of your kidneys.

3. It depends on whether they are fat based or water based.

4. It depends on the amount of blood flow to your body tissues.

5. It depends on the health of your liver.

Correct Answer: 1,3,4

Rationale 1: Distribution of drugs depends on the amount of blood flow to body tissues, the lipid solubility of the drug, and protein binding. The health of the liver refers to metabolism, not distribution. The health of the kidneys refers to excretion, not distribution.

Rationale 2: Distribution of drugs depends on the amount of blood flow to body tissues, the lipid solubility of the drug, and protein binding. The health of the liver refers to metabolism, not distribution. The health of the kidneys refers to excretion, not distribution.

Rationale 3: Distribution of drugs depends on the amount of blood flow to body tissues, the lipid solubility of the drug, and protein binding. The health of the liver refers to metabolism, not distribution. The health of the kidneys refers to excretion, not distribution.

Rationale 4: Distribution of drugs depends on the amount of blood flow to body tissues, the lipid solubility of the drug, and protein binding. The health of the liver refers to metabolism, not distribution. The health of the kidneys refers to excretion, not distribution.

Rationale 5: Distribution of drugs depends on the amount of blood flow to body tissues, the lipid solubility of the drug, and protein binding. The health of the liver refers to metabolism, not distribution. The health of the kidneys refers to excretion, not distribution.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4-6

Question 13

Type: MCSA

The patient receives a drug that is excreted in the bile. What will the best nursing assessment of the effect of this drug on the patient include?

1. The effect of the drug will be a prolonged action.

2. The effect of the drug will be increased side effects.

3. The effect of the drug will be decreased side effects.

4. The effect of the drug will be decreased.

Correct Answer: 1

Rationale 1: Most bile is circulated back to the liver so drugs secreted into the bile will be recirculated numerous times with the bile, resulting in a prolonged action of the drug. Bile-excreted drugs do not have a decreased effect, nor are side effects decreased. Side effects may or may not be increased; this is dose dependent.

Rationale 2: Most bile is circulated back to the liver so drugs secreted into the bile will be recirculated numerous times with the bile, resulting in a prolonged action of the drug. Bile-excreted drugs do not have a decreased effect, nor are side effects decreased. Side effects may or may not be increased; this is dose dependent.

Rationale 3: Most bile is circulated back to the liver so drugs secreted into the bile will be recirculated numerous times with the bile, resulting in a prolonged action of the drug. Bile-excreted drugs do not have a decreased effect, nor are side effects decreased. Side effects may or may not be increased; this is dose dependent.

Rationale 4: Most bile is circulated back to the liver so drugs secreted into the bile will be recirculated numerous times with the bile, resulting in a prolonged action of the drug. Bile-excreted drugs do not have a decreased effect, nor are side effects decreased. Side effects may or may not be increased; this is dose dependent.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 4-9

Question 14

Type: MCSA

The nurse administers medications by various routes of delivery. The nurse recognizes which route of administration as requiring higher dosages of drugs to achieve a therapeutic effect?

1. Intravenous route

2. Oral route

3. Rectal route

4. Sublingual route

Correct Answer: 2

Rationale 1: Oral medications pass into the hepatoportal circulation and may be completely metabolized before reaching the general circulation. This so-called first pass effect may necessitate the use of higher dosages of oral medications to achieve a therapeutic effect. None of the other routes, sublingual, rectal, or intravenous, are affected by the first-pass effect.

Rationale 2: Oral medications pass into the hepatoportal circulation and may be completely metabolized before reaching the general circulation. This so-called first pass effect may necessitate the use of higher dosages of oral medications to achieve a therapeutic effect. None of the other routes, sublingual, rectal, or intravenous, are affected by the first-pass effect.

Rationale 3: Oral medications pass into the hepatoportal circulation and may be completely metabolized before reaching the general circulation. This so-called first pass effect may necessitate the use of higher dosages of oral medications to achieve a therapeutic effect. None of the other routes, sublingual, rectal, or intravenous, are affected by the first-pass effect.

Rationale 4: Oral medications pass into the hepatoportal circulation and may be completely metabolized before reaching the general circulation. This so-called first pass effect may necessitate the use of higher dosages of oral medications to achieve a therapeutic effect. None of the other routes, sublingual, rectal, or intravenous, are affected by the first-pass effect.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 4-5

Question 15

Type: MCSA

Enzymatic activity that changes a medication into a less active form is an example of

1. pharmacodynamics.

2. active transport.

3. pharmacokinetics.

4. diffusion.

Correct Answer: 3

Rationale 1: Pharmacokinetics describes how drugs are handled within the body. Pharmacodynamics involves how drugs change the body. Diffusion is the movement of a chemical from an area of higher concentration to an area of lower concentration. Active transport is the movement of a chemical against concentration or gradient. (p. 37)

Rationale 2: Pharmacokinetics describes how drugs are handled within the body. Pharmacodynamics involves how drugs change the body. Diffusion is the movement of a chemical from an area of higher concentration to an area of lower concentration. Active transport is the movement of a chemical against concentration or gradient. (p. 37)

Rationale 3: Pharmacokinetics describes how drugs are handled within the body. Pharmacodynamics involves how drugs change the body. Diffusion is the movement of a chemical from an area of higher concentration to an area of lower concentration. Active transport is the movement of a chemical against concentration or gradient. (p. 37)

Rationale 4: Pharmacokinetics describes how drugs are handled within the body. Pharmacodynamics involves how drugs change the body. Diffusion is the movement of a chemical from an area of higher concentration to an area of lower concentration. Active transport is the movement of a chemical against concentration or gradient. (p. 37)

Global Rationale:

Cognitive Level: Understanding

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 4-1

Question 16

Type: MCSA

Which of the following are the four categories of pharmacokinetics?

1. Diffusion, active transport, interspersing, and storage

2. Ingestion, metabolism, interspersing, and excretion

3. Absorption, distribution, metabolism, and excretion

4. Ingestion, settling, movement, and storage

Correct Answer: 3

Rationale 1: The four categories of pharmacokinetics are absorption, distribution, metabolism, and excretion.

Rationale 2: The four categories of pharmacokinetics are absorption, distribution, metabolism, and excretion.

Rationale 3: The four categories of pharmacokinetics are absorption, distribution, metabolism, and excretion.

Rationale 4: The four categories of pharmacokinetics are absorption, distribution, metabolism, and excretion.

Global Rationale:

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 4-2

Question 17

Type: MCSA

Following ingestion, a drug crosses a membrane from an area of higher concentration to an area of lower concentration. This is an example of

1. active transport.

2. osmosis.

3. diffusion.

4. metabolism.

Correct Answer: 3

Rationale 1: Diffusion is the movement of a chemical from an area of higher concentration to an area of lower concentration. Active transport is the movement of a chemical against concentration or gradient. Osmosis involves the movement of water, and metabolism involves chemical conversion. (pp. 3740)

Rationale 2: Diffusion is the movement of a chemical from an area of higher concentration to an area of lower concentration. Active transport is the movement of a chemical against concentration or gradient. Osmosis involves the movement of water, and metabolism involves chemical conversion. (pp. 3740)

Rationale 3: Diffusion is the movement of a chemical from an area of higher concentration to an area of lower concentration. Active transport is the movement of a chemical against concentration or gradient. Osmosis involves the movement of water, and metabolism involves chemical conversion. (pp. 3740)

Rationale 4: Diffusion is the movement of a chemical from an area of higher concentration to an area of lower concentration. Active transport is the movement of a chemical against concentration or gradient. Osmosis involves the movement of water, and metabolism involves chemical conversion. (pp. 3740)

Global Rationale:

Cognitive Level: Understanding

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 4-3

Question 18

Type: MCSA

Aspirin is ionized as it enters the small intestine. Which statement is accurate regarding the absorption of aspirin in the small intestine?

1. Absorption is decreased.

2. Absorption is increased.

3. Ionization has nothing to do with the absorption rate.

4. Aspirin must travel past the small intestine for absorption to occur.

Correct Answer: 1

Rationale 1: The small intestine is a more alkaline environment, which facilitates the absorption of basic drugs. Aspirin is an acidic drug that is ionized in the small intestine, and will have lower absorption rates. Higher rates of absorption occur in the stomach (an acidic environment).

Rationale 2: The small intestine is a more alkaline environment, which facilitates the absorption of basic drugs. Aspirin is an acidic drug that is ionized in the small intestine, and will have lower absorption rates. Higher rates of absorption occur in the stomach (an acidic environment).

Rationale 3: The small intestine is a more alkaline environment, which facilitates the absorption of basic drugs. Aspirin is an acidic drug that is ionized in the small intestine, and will have lower absorption rates. Higher rates of absorption occur in the stomach (an acidic environment).

Rationale 4: The small intestine is a more alkaline environment, which facilitates the absorption of basic drugs. Aspirin is an acidic drug that is ionized in the small intestine, and will have lower absorption rates. Higher rates of absorption occur in the stomach (an acidic environment).

Global Rationale:

Cognitive Level: Understanding

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 4-4

Question 19

Type: MCSA

Which statement regarding medication distribution within the body is accurate?

1. The bloodbrain barrier inhibits rapid crossing of all medications.

2. Body organs with high levels of blood flow are more difficult organs to which to deliver drugs.

3. Medications that are lipid-soluble are more completely distributed.

4. Drugprotein complexes must form prior to crossing capillary membranes.

Correct Answer: 3

Rationale 1: Lipid-soluble medications are absorbed and distributed quicker and more quickly than those that are not. Body organs with low levels of blood flow are more difficult organs to which to deliver drugs. When medications bind to proteins, their size increases, preventing them from passing through capillary membranes. Some medications (sedatives) are able to rapidly cross the bloodbrain barrier. (pp. 3940)

Rationale 2: Lipid-soluble medications are absorbed and distributed quicker and more quickly than those that are not. Body organs with low levels of blood flow are more difficult organs to which to deliver drugs. When medications bind to proteins, their size increases, preventing them from passing through capillary membranes. Some medications (sedatives) are able to rapidly cross the bloodbrain barrier. (pp. 3940)

Rationale 3: Lipid-soluble medications are absorbed and distributed quicker and more quickly than those that are not. Body organs with low levels of blood flow are more difficult organs to which to deliver drugs. When medications bind to proteins, their size increases, preventing them from passing through capillary membranes. Some medications (sedatives) are able to rapidly cross the bloodbrain barrier. (pp. 3940)

Rationale 4: Lipid-soluble medications are absorbed and distributed quicker and more quickly than those that are not. Body organs with low levels of blood flow are more difficult organs to which to deliver drugs. When medications bind to proteins, their size increases, preventing them from passing through capillary membranes. Some medications (sedatives) are able to rapidly cross the bloodbrain barrier. (pp. 3940)

Global Rationale:

Cognitive Level: Understanding

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 4-6 and 4-7

Question 20

Type: MCSA

Which organ is the most responsible for the first-pass effect?

1. Bladder

2. Kidneys

3. Liver

4. Stomach

Correct Answer: 3

Rationale 1: The first pass effect occurs in the liver.

Rationale 2: The first pass effect occurs in the liver.

Rationale 3: The first pass effect occurs in the liver.

Rationale 4: The first pass effect occurs in the liver.

Global Rationale:

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 4-5

Question 21

Type: MCSA

Which of the following substances would have the lowest rate of crossing renal tubular membranes, and would therefore be excreted in the urine?

1. Lipid-soluble drugs

2. Water

3. Ionized drugs

4. Non-ionized drugs

Correct Answer: 3

Rationale 1: Ionized and water-soluble drugs are less likely to cross renal tubular walls, and will therefore be excreted.

Rationale 2: Ionized and water-soluble drugs are less likely to cross renal tubular walls, and will therefore be excreted.

Rationale 3: Ionized and water-soluble drugs are less likely to cross renal tubular walls, and will therefore be excreted.

Rationale 4: Ionized and water-soluble drugs are less likely to cross renal tubular walls, and will therefore be excreted.

Global Rationale:

Cognitive Level: Remembering

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 4-8

Question 22

Type: MCSA

Which statement is accurate regarding medications that end up being secreted in bile?

1. All medications secreted in bile are excreted in the feces.

2. Some medications are excreted in the feces while others can be recirculated to the liver many times.

3. Most medications secreted in bile are metabolized in the gallbladder.

4. Generally, medications are not secreted in the bile.

Correct Answer: 2

Rationale 1: Most bile is circulated back to the liver by enterohepatic circulation, where medications are metabolized in the liver. Some bile (and medications within) is excreted in the feces.

Rationale 2: Most bile is circulated back to the liver by enterohepatic circulation, where medications are metabolized in the liver. Some bile (and medications within) is excreted in the feces.

Rationale 3: Most bile is circulated back to the liver by enterohepatic circulation, where medications are metabolized in the liver. Some bile (and medications within) is excreted in the feces.

Rationale 4: Most bile is circulated back to the liver by enterohepatic circulation, where medications are metabolized in the liver. Some bile (and medications within) is excreted in the feces.

Global Rationale:

Cognitive Level: Understanding

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 4-9

Question 23

Type: MCSA

Which of the following would most accurately indicate that a therapeutic range for a medication had been reached?

1. No serious adverse effects are experienced following administration.

2. The indication for administration was achieved without serious side effects.

3. A pre-specified amount (in milligrams) was administered.

4. The medication was effective, but the patient experienced a lethal dysrhythmia.

Correct Answer: 2

Rationale 1: The therapeutic range of a drug is between the minimum effective concentration and the toxic concentration.

Rationale 2: The therapeutic range of a drug is between the minimum effective concentration and the toxic concentration.

Rationale 3: The therapeutic range of a drug is between the minimum effective concentration and the toxic concentration.

Rationale 4: The therapeutic range of a drug is between the minimum effective concentration and the toxic concentration.

Global Rationale:

Cognitive Level: Understanding

Client Need: Physiological Integrity

Client Need Sub:

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 4-11

Question 24

Type: MCMA

The nurse is teaching a patient the importance of taking the medication as prescribed. Patient teaching is guided by the nurses knowledge of which principles of pharmacokinetics?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. A medication taken by injection must cross the membranes of the gastrointestinal tract to get to the blood stream before it can be distributed throughout the body.

2. A drug may be exposed to several physiological processes while en route to target cells.

3. Liver enzymes may chemically change the drug.

4. Excretion organs such as kidneys and intestines must be healthy enough to eliminate the drug.

5. Many processes to which drugs are exposed are destructive, thereby helping facilitate the drugs movement throughout the body.

Correct Answer: 2,3,4,5

Rationale 1: Medications taken by mouth must cross the membranes of the GI tracts to get to the blood stream in order to be distributed throughout the body. This is not the case for medications administered by injection.

Rationale 2: Drugs taken orally are often exposed to physiological processes such as stomach acid and digestive enzymes.

Rationale 3: Enzymes in the liver may chemically change some drugs.

Rationale 4: Drugs will continue to act on the body until they are either metabolized to an inactive form or are excreted. Pathologic states such as kidney disease can increase the drugs action on the body.

Rationale 5: Many destructive processes, such as when stomach acid breaks down food, can break down the drug molecule before it can reach the target cells. This will facilitate the drugs movement throughout the body.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4-1

Question 25

Type: MCMA

The nurse is reviewing the role of diffusion in the distribution of medications. Drugs that cannot be distributed by simple diffusion include those with which characteristics?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Large molecules

2. Ionization

3. Water-soluble agents

4. Alcohol

5. Urea

Correct Answer: 1,2,3

Rationale 1: Large molecules have difficulty crossing plasma membranes by simple diffusion.

Rationale 2: Ionized drugs have difficulty crossing plasma membranes by simple diffusion. These drugs may require carrier, or transport, proteins to cross membranes.

Rationale 3: Water-soluble agents have difficulty crossing plasma membranes by simple diffusion.

Rationale 4: Diffusion assumes that the chemical is able to freely cross the plasma membrane. Drugs may also enter through open channels in the plasma membrane; however, the molecule must be very small, such as alcohol.

Rationale 5: Diffusion assumes that the chemical is able to freely cross the plasma membrane. Drugs may also enter through open channels in the plasma membrane; however, the molecule must be very small, such as urea.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Evaluation

Learning Outcome: 4-2

Question 26

Type: MCMA

The nurse is preparing an intramuscular (IM) injection for a patient with strep throat. What principles of absorption may have guided the health care providers decision to order the medication by IM route?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. IM drugs are rapidly absorbed.

2. IM drugs bypass the gastrointestinal tract, resulting in increased absorption.

3. IM drugs avoid drug?drug and food?drug interactions, which can decrease absorption.

4. IM drugs have the ability to accumulate in the muscle and may remain in the body for an extended amount of time.

5. IM drugs bypass the gastrointestinal tract and are delivered to the small intestine, where most medications are rapidly absorbed.

Correct Answer: 1,2,3

Rationale 1: Muscles have a high blood flow, which maximizes absorption.

Rationale 2: The thick mucous layer of the stomach decreases absorption. IM drugs bypass this obstacle, resulting in increased absorption.

Rationale 3: Oral medications and food can interfere with absorption of medications. Bypassing the gastrointestinal tract will remove this possibility.

Rationale 4: Some tissues do have the ability to accumulate and store drugs. Muscle tissue is not one of these. The bone marrow, teeth, eyes, and adipose tissue have an affinity to store drugs.

Rationale 5: IM drugs do bypass the gastrointestinal tract but are not exposed to the small intestine. IM drugs are absorbed from the muscle into the blood stream.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4-3

Question 27

Type: MCMA

A patient is admitted to the burn unit with 75% body surface area burns. Which orders would be appropriate for this patient to control pain?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Morphine 10 mg IV every 2 to 4 hours as needed for pain

2. Morphine 10 mg IM every 2 to 4 hours as needed for pain.

3. Morphine 10 mg transdermal patch every 2 to 4 hours as needed for pain.

4. Morphine 10 mg sublingual every 2 to 4 hours as needed for pain.

5. Morphine 10 mg subcutaneous every 2 to 4 hours as need for pain.

Correct Answer: 1,4

Rationale 1: Pain medication given by the intravenous (IV) route will be rapidly and completely absorbed.

Rationale 2: The patient has 75% surface area burns; there may not be an area available for intramuscular injections of morphine.

Rationale 3: The patient has 75% surface area burns; there may not be an area available to place a transdermal patch.

Rationale 4: Sublingual morphine can be used as a rescue drug.

Rationale 5: The patient has 75% surface area burns; there may not be an area available for subcutaneous injections.

Global Rationale:

Cognitive Level: Analyzing

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 4-4

Question 28

Type: MCMA

The nurse recognizes that medications can be excreted by which routes?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Fecal

2. Gastric

3. Glandular

4. Pulmonary

5. Renal

Correct Answer: 1,3,4,5

Rationale 1: Drugs can be excreted via feces.

Rationale 2: Drugs are not excreted through the gastric system.

Rationale 3: Drugs can be secreted glandularly.

Rationale 4: Drugs can be secreted via the lungs.

Rationale 5: Drugs can be excreted by the renal route.

Global Rationale:

Cognitive Level: Understanding

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4-7

Question 29

Type: MCMA

A patient asks the nurse why he experiences a metallic taste after taking certain medications. The nurse explains that a medication may cause glandular secretions that occur by which routes?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Saliva

2. Sweat

3. Breast milk

4. Urine

5. Feces

Correct Answer: 1,2,3

Rationale 1: Water-soluble drugs may be secreted into the saliva, which can cause a funny taste after the administration of a medication.

Rationale 2: Water-soluble drugs may be secreted into the sweat, which may cause an odor to be omitted by the person who has taken a medication.

Rationale 3: Water-soluble drugs may be secreted into the breast milk. Breastfeeding mothers must use caution in regards to medications while lactating as the medications can be passed to their infants via the breast milk.

Rationale 4: Urine is excreted by the kidneys and does not play a role in glandular activity.

Rationale 5: Feces are excreted by the gastrointestinal system and do not play a role in glandular activity.

Global Rationale:

Cognitive Level: Applying

Client Need: Physiological Integrity

Client Need Sub: Pharmacological and Parenteral Therapies

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 4-7

Adams, Pharmacology for Nurse: A Pathophysiologic Approach, 4/E

Copyright 2014 by Pearson Education, Inc.

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