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Lilley: Pharmacology and the Nursing Process, 6th Edition

Test Bank

Chapter 02: Pharmacologic Principles

MULTIPLE CHOICE

1. A patient is receiving two different drugs. At current dosages and dosage forms, both drugs are absorbed into the circulation in identical amounts. Thus, because they have the same absorption rates, they are
A. in a steady state.
B. synergistic.
C. compatible.
D. bioequivalent.

ANS: D
Two drugs absorbed into the circulation in the same amount (in specific dosage forms) have the same bioavailability; thus, they are bioequivalent. A drug’s steady state is the physiologic state in which the amount of drug removed via elimination is equal to the amount of drug absorbed from each dose. The term synergistic refers to two drugs, given together, with a resulting effect that is greater than the sum of the effects of each drug given alone. The term compatible is a general term that indicates that two substances do not produce a chemical reaction when mixed (or given, in the case of drugs) together.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 20
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

2. When given an intravenous (IV) medication, the patient says to the nurse, “I usually take pills. Why does this medication have to be given in the arm?” What is the nurse’s best answer?
A. “The medication will cause fewer adverse effects when given intravenously.”
B. “The IV medication will be absorbed slowly into the tissues over time.”
C. “The action of the medication will begin sooner when given intravenously.”
D. “There is a lower chance of allergic reactions when drugs are given IV.”

ANS: C
An IV injection provides the fastest route of absorption. The IV route does not affect the number of adverse effects. The IV route does not result in slow absorption but in fast absorption. The IV route does not affect the number of allergic reactions.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 22
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

3. The nurse is administering parenteral drugs. Which statement is true regarding parenteral drugs?
A. Parenteral drugs bypass the first-pass effect.
B. Absorption of parenteral drugs is affected by reduced blood flow to the stomach.
C. Absorption of parenteral drugs is altered by the presence of food in the stomach.
D. Parenteral drugs exert their effects while circulating in the bloodstream.

ANS: A
Drugs given by the parenteral route bypass the first-pass effect. Reduced blood flow to the stomach and the presence of food in the stomach apply to enteral drugs (taken orally), not to parenteral drugs. Parenteral drugs must be absorbed into cells and tissues from the circulation before they can exert their effects; they do not exert their effects while circulating in the bloodstream.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 21
TOP: NURSING PROCESS: General
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

4. When monitoring a patient on an insulin drip to reduce blood glucose levels, the nurse notes that the patient’s glucose level is extremely low, and the patient is lethargic and difficult to awaken. This would be classified as which type of adverse drug reaction?
A. An adverse effect
B. An allergic reaction
C. An idiosyncratic reaction
D. A pharmacologic reaction

ANS: D
A pharmacologic reaction is an extension of a drug’s normal effects in the body. In this case, the insulin lowered the patient’s blood glucose levels too much. The other options do not describe a pharmacologic reaction. An adverse effect is a predictable, well-known adverse drug reaction that results in minor or no changes in patient management. An allergic reaction (also known as a hypersensitivity reaction) involves the patient’s immune system. An idiosyncratic reaction is unexpected and is defined as a genetically determined abnormal response to normal dosages of a drug.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 32
TOP: NURSING PROCESS: General
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

5. When reviewing pharmacology terms for a group of newly graduated nurses, the nurse explains that a drug’s half-life is the time it takes for
A. the drug to elicit half of its therapeutic response.
B. one half of the original amount of a drug to reach the target cells.
C. one half of the original amount of a drug to be removed from the body.
D. one half of the original amount of a drug to be absorbed into the circulation.

ANS: C
A drug’s half-life is the time it takes for one half of the original amount of a drug to be removed from the body. It is a measure of the rate at which drugs are removed from the body. The other options are not correct definitions of half-life.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 26
TOP: NURSING PROCESS: General
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

6. When administering drugs, the nurse remembers that the duration of action of a drug is defined as the time it takes
A. for a drug to elicit a therapeutic response.
B. for a drug to achieve its maximum therapeutic response.
C. to remove a drug from circulation.
D. for a drug’s concentration to be sufficient to cause a therapeutic response.

ANS: D
Duration of action is the time during which drug concentration is sufficient to elicit a therapeutic response. The other options do not define duration of action. A drug’s onset of action is the time it takes for the drug to elicit a therapeutic response. A drug’s peak effect is the time it takes for the drug to reach its maximum therapeutic response. Elimination is the length of time it takes to remove a drug from circulation.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 27
TOP: NURSING PROCESS: General
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

7. When reviewing the mechanism of action of a specific drug, the nurse reads that the drug works by selective enzyme interaction. This process occurs when the drug
A. alters cell membrane permeability.
B. is attracted to a receptor on the cell wall, preventing an enzyme from binding to that receptor.
C. enhances its effectiveness within the cell walls of the target tissue.
D. attracts enzymes to bind with it instead of the enzymes’ normal target cells, blocking the action of the enzymes.

ANS: D
With selective enzyme interaction, the drug attracts the enzymes to bind with the drug instead of allowing the enzymes to bind with their normal target cells. As a result, the target cells are protected from the action of the enzymes. This results in a drug effect. The actions described in the other options do not occur with selective enzyme interactions.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 28
TOP: NURSING PROCESS: General
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

8. When administering a new medication to a patient, the nurse reads that it is highly protein-bound. The nurse should expect which result?
A. Renal excretion will take longer.
B. The length of time for drug metabolism will be shorter.
C. The duration of action of the medication will be longer.
D. The duration of action of the medication will be shorter.

ANS: C
Drugs that are bound to plasma proteins are characterized by longer duration of action. Protein binding does not make renal excretion longer, does not make the length of time of drug metabolism shorter, and does cause the duration of action to be shorter.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 24
TOP: NURSING PROCESS: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

9. A patient is experiencing chest pain and needs to take a sublingual form of nitroglycerin. Where does the nurse instruct the patient to place the tablet?
A. Under the tongue
B. In the space between the cheek and the gum inside the mouth
C. At the back of the throat for easy swallowing
D. On a nonhairy area of the chest

ANS: A
Drugs administered via the sublingual route are placed under the tongue. Drugs administered via the buccal route are placed in the space between the cheek and the gum; oral drugs are swallowed. The nonhairy area of the chest is for topical or transdermal routes.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 21
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

10. The nurse is administering medications to a patient who is in liver failure resulting from end-stage cirrhosis. The nurse is aware that patients with liver failure would most likely have problems with which pharmacokinetic phase?
A. Absorption
B. Distribution
C. Metabolism
D. Excretion

ANS: C
The liver is the organ that is most responsible for drug metabolism. Decreased liver function most strongly affects the metabolism of a drug. The absorption and distribution of a drug are not affected by liver function. Excretion is affected only because decreased liver function may not transform drugs into water-soluble substances for elimination via the kidneys, but that is not the best answer for this question.
DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 25
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

11. A patient who has advanced cancer is receiving opioid medications around the clock to keep him comfortable as he nears the end of his life. Which term best describes this type of therapy?
A. Palliative therapy
B. Maintenance therapy
C. Acute therapy
D. Supplemental therapy

ANS: A
The goal of palliative therapy is to make the patient as comfortable as possible. It is typically used in the end stages of illnesses when all attempts at curative therapy have failed. Maintenance therapy is used for the treatment of chronic illnesses such as hypertension. Acute therapy is more intensive drug treatment and is implemented in the acutely ill (those with rapid onset of illness) or even in the critically ill; it is often needed to sustain life or treat disease. Supplemental or replacement therapy supplies the body with a substance needed to maintain normal function.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 29
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

12. The nurse gave a sleeping pill to an elderly patient at bedtime. Two hours later, the patient is irritable and restless and unable to sleep. The nurse recognizes that the patient’s response is reflective of which reaction?
A. Allergic reaction
B. Mutagenic effect
C. Idiosyncratic reaction
D. Teratogenic reaction

ANS: C
An idiosyncratic reaction is not the result of a known pharmacologic property of a drug or of a patient allergy but instead occurs unexpectedly in a particular patient. Such a reaction is a genetically determined abnormal response to normal dosages of a drug. An allergic reaction (also known as a hypersensitivity reaction) involves the patient’s immune system. Mutagenic effects are permanent changes in the genetic composition of living organisms and consist of alterations in chromosome structure, the number of chromosomes, or the genetic code of the deoxyribonucleic acid (DNA) molecule. Teratogenic effects of drugs or other chemicals result in structural defects in the fetus.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 32
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies
MULTIPLE RESPONSE

1. Of the drugs listed below, which would be affected by the first-pass effect? Select all that apply.
A. morphine infusion through a patient-controlled analgesia pump
B. nitroglycerin sublingual tablets
C. diphenhydramine (Benadryl) elixir
D. levothyroxine (Synthroid) tablets
E. Transdermal nicotine patches
F. nifedipine (Procardia) capsules
G. penicillin given by IV piggyback infusion

ANS: C, D, F
Orally administered drugs (elixirs, tablets, capsules) undergo the first-pass effect because they are metabolized in the liver after being absorbed into the portal circulation from the small intestine. Infusions and IV piggyback medications enter the bloodstream directly and do not go directly to the liver. Sublingual tablets and transdermal patches also enter the bloodstream without going directly to the liver, thus avoiding the first-pass effect.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Pages 20-23
TOP: NURSING PROCESS: General
MSC: NCLEX: Physiological Integrity: Pharmacological Therapies

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