Chapter 2 Flashcards
The patient is receiving two different drugs. At current dosages and dosage forms, both drugs are
absorbed into the circulation in identical amounts. Which term is used to identify this principle?
a. Bioequivalent
b. Synergistic
c. Prodrugs
d. Steady state
ANS: A
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. A prodrug is an inactive drug
dosage form that is converted to an active metabolite by various biochemical reactions once it is
inside the body.
When given an intravenous 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 intravenous medication will have delayed absorption into the body’s tissues.”
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 intravenously.”
ANS: C
An intravenous (IV) injection provides the fastest route of absorption. The IV route does not affect the number of adverse effects, nor does it cause delayed tissue absorption (it results in faster absorption). The IV route does not affect the number of allergic reactions.
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 faster when the stomach is empty.
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.
When monitoring the patient receiving an intravenous infusion to reduce blood pressure, the
nurse notes that the patient’s blood pressure is extremely low, and the patient is lethargic and
difficult to awaken. This would be classified as which type of adverse drug reaction?
a. Adverse effect
b. Allergic reaction
c. Idiosyncratic reaction
d. Pharmacologic reaction
ANS: D
A pharmacologic reaction is an extension of a drug’s normal effects in the body. In this case, the
antihypertensive drug lowered the patient’s blood pressure 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.
The nurse is reviewing pharmacology terms for a group of newly graduated nurses. Which
sentence defines a drug’s half-life?
a. The time it takes for the drug to cause half of its therapeutic response
b. The time it takes for one half of the original amount of a drug to reach the target
cells
c. The time it takes for one half of the original amount of a drug to be removed from
the body
d. The time it takes for 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 incorrect definitions of half-life.
When administering drugs, the nurse remembers that the duration of action of a drug is defined
as which of these?
a. The time it takes for a drug to elicit a therapeutic response
b. The amount of time needed to remove a drug from circulation
c. The time it takes for a drug to achieve its maximum therapeutic response
d. The time period at which a drug’s concentration is 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.
When reviewing the mechanism of action of a specific drug, the nurse reads that the drug works
by selective enzyme interaction. Which of these processes describes selective enzyme
interaction?
a. The drug alters cell membrane permeability.
b. The drug’s effectiveness within the cell walls of the target tissue is enhanced.
c. The drug is attracted to a receptor on the cell wall, preventing an enzyme from
binding to that receptor.
d. The drug binds to an enzyme molecule and inhibits or enhances the enzyme’s
action with the normal target cell.
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.
When administering a new medication to a patient, the nurse reads that it is highly protein bound.
Assuming that the patient’s albumin levels are normal, the nurse would expect which result, as
compared to a medication that is not highly protein bound?
a. Renal excretion will be faster.
b. The drug will be metabolized quickly.
c. The duration of action of the medication will be shorter.
d. The duration of action of the medication will be longer.
ANS: D
Drugs that are bound to plasma proteins are characterized by longer duration of action. Protein
binding does not make renal excretion faster, does not speed up drug metabolism, and does not
cause the duration of action to be shorter.
The 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. On top of the tongue
c. At the back of the throat
d. In the space between the cheek and the gum
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 other options are incorrect
The nurse is administering medications to the patient who is in renal failure resulting from endstage renal disease. The nurse is aware that patients with kidney failure would most likely have
problems with which pharmacokinetic phase?
a. Absorption
b. Distribution
c. Metabolism
d. Excretion
ANS: D
The kidneys are the organs that are most responsible for drug excretion. Renal function does not
affect the absorption and distribution of a drug. Renal function may affect metabolism of drugs
to a small extent.
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. Empiric 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. Empiric therapy is
based on clinical probabilities and involves drug administration when a certain pathologic
condition has an uncertain but high likelihood of occurrence based on the patient’s initial
presenting symptoms. Supplemental (or replacement therapy) supplies the body with a substance
needed to maintain normal function.
The patient is complaining of a headache and asks the nurse which over-the-counter medication
form would work the fastest to help reduce the pain. Which medication form will the nurse
suggest?
a. A capsule
b. A tablet
c. An enteric-coated tablet
d. A powder
ANS: D
Of the types of oral medications listed, the powder form would be absorbed the fastest, thus
having a faster onset. The tablet, the capsule, and, finally, the enteric-coated tablet would be
absorbed next, in that order.
The nurse will be injecting a drug into the fatty tissue of the patient’s abdomen. Which route does this describe? a. Intradermal b. Subcutaneous c. Intramuscular d. Transdermal
ANS: B
Injections into the fatty subcutaneous tissue under the dermal layer of skin are referred to as
subcutaneous injections. Injections under the more superficial skin layers immediately
underneath the epidermal layer of skin and into the dermal layer are known as intradermal
injections. Injections into the muscle beneath the subcutaneous fatty tissue are referred to as
intramuscular injections. Transdermal drugs are applied to the skin via an adhesive patch.
Which drugs would be affected by the first-pass effect? (Select all that apply.)
a. Morphine given by IV push injection
b. Sublingual nitroglycerin tablets
c. Diphenhydramine (Benadryl) elixir
d. Levothyroxine (Synthroid) tablets
e. Transdermal nicotine patches
f. Esomeprazole (Nexium) 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. IV medications (IV push and IV piggyback) 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.
