Unit 1and2 Ch2

Question 1

The patient is receiving two different drugs. At current dosages and dosage forms, both drugs have the same concentration of the active ingredient. Which term is used to identify this principle?
a. Bioequivalent
b. Synergistic
c. Prodrugs
d. Steady state

Answer 1

A

Two drugs absorbed into the circulation in the same amount (in specific dosage forms) have the same bioavailability; thus, they are bioequivalent.

Question 2

When given an intravenous medication, the patient says to the nurse, “I usually take pills. Why does this medication have to begiven 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.”

Answer 2

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
reaction

Question 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 faster when the stomach is empty.
d. Parenteral drugs exert their effects while circulating in the bloodstream.

Answer 3

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

Question 4

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

Answer 4

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.

Question 5

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

Answer 5

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

Question 6

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

Answer 6

D
Duration of action is the time during which drug’s concentration is sufficient to elicit a therapeutic response.

Question 7

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

Answer 7

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.

Question 8

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

Answer 8

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

Question 9

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

Answer 9

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

Question 10

The nurse is administering medications to the patient who is in renal failure resulting from end-stage 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

Answer 10

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.

Question 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. Empiric therapy
d. Supplemental therapy

Answer 11

A
The goal of palliative therapy is to make the patient as comfortable as possible.

Question 12

The nurse will be injecting a drug into the superficial skin layers immediately underneath the epidermal layer of skin. Which route
does this describe?
a. Intradermal
b. Subcutaneous
c. Intramuscular
d. Transdermal

Answer 12

A
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 fatty subcutaneous tissue under the dermal layer of skin are referred to as
subcutaneous 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.

Question 13

Which drugs would be affected by the first-pass effect when administered? (Select all that apply.)
a. Morphine given by IV push injection
b. Sublingual nitroglycerin tablets
c. Diphenhydramine (Benadryl) elixirs
d. Levothyroxine (Synthroid) tablets
e. Transdermal nicotine patches
f. Esomeprazole (Nexium) capsules
g. Penicillin given by IV piggyback infusion

Answer 13

C, D, F
Orally administered drugs (elixirs, tablets, and 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.

Question 14

A drug dose that delivers 800 mg has a half-life of 5 hours. Identify how much drug will remain in the body after one half-life.
______

Answer 14

400 mg
A drug’s half-life is the time required for one half of an administered dose of a drug to be eliminated by the body, or the time it
takes for the blood level of a drug to be reduced by 50%. Therefore, one half of 800 mg equals 400 mg

Question 15

When involved in phase III drug evaluation studies, what responsibilities would the nurse have?
A) Working with animals who are given experimental drugs
B) Choosing appropriate patients to be involved in the drug study
C) Monitoring and observing patients closely for adverse effects
D) Conducting research to determine effectiveness of the drugs

Answer 15

C

Phase III studies involve use of a drug in a vast clinical population in which patients are asked to record
any symptoms they experience while taking the drugs. Nurses may be responsible for helping collect
and analyze the information to be shared with the Food and Drug Administration (FDA) but would not
conduct research independently because nurses do not prescribe medications.

Question 16

What concept is considered when generic drugs are substituted for brand name drugs?
A) Bioavailability
B) Critical concentration
C) Distribution
D) Half-life

Answer 16

A

Bioavailability is the portion of a dose of a drug that reaches the systemic circulation and is available to
act on body cells.

Question 17

A nurse is assessing the patient’s home medication use. After listening to the patient list current
medications, the nurse asks what priority question

A) Do you take any generic medications?
B) Are any of these medications orphan drugs?
C) Are these medications safe to take during pregnancy?
D) Do you take any over-the-counter medications

Answer 17

D

It is important for the nurse to specifically question use of over-the-counter medications because
patients may not consider them important.

Question 18

A nurse is instructing a pregnant patient concerning the potential risk to her fetus from a Pregnancy
Category B drug. What would the nurse inform the patient

A) Adequate studies in pregnant women have demonstrated there is no risk to the fetus.
B) Animal studies have not demonstrated a risk to the fetus, but there have been no adequate studies
in pregnant women.
C) Animal studies have shown an adverse effect on the fetus, but there are no adequate studies in
pregnant women.
D) There is evidence of human fetal risk, but the potential benefits from use of the drug may be
acceptable despite potential risks

Answer 18

B

Category B indicates that animal studies have not demonstrated a risk to the fetus. However, there have
not been adequate studies in pregnant women to demonstrate risk to a fetus during the first trimester of
pregnancy and no evidence of risk in later trimesters. Category A indicates that adequate studies in
pregnant women have not demonstrated a risk to the fetus in the first trimester or in later trimesters.
Category C indicates that animal studies have shown an adverse effect on the fetus, but no adequate
studies in humans. Category D reveals evidence of human fetal risk, but the potential benefits from the
use of the drugs in pregnant women may outweigh potential risks

Question 19

What would be the best source of drug information for a nurse?
A) Drug Facts and Comparisons
B) A nurse’s drug guide
C) A drug package insert
D) The Physicians’ Drug Reference (PDR)

Answer 19

B

A nurse’s drug guide provides nursing implications and patient teaching points that are most useful to
nurses in addition to need-to-know drug information in a very user friendly organizational
style.Lippincott’s Nursing Drug Guide (LNDG) has drug monographs organized alphabetically and
includes nursing implications and patient teaching points

Question 20

The nurse is preparing to administer a medication from a multidose bottle. The label is torn and soiled
but the name of the medication is still readable. What is the nurse’s priority action?
A) Discard the entire bottle and contents and obtain a new bottle.
B) Find the drug information and create a new label for the bottle.
C) Ask another nurse to verify the contents of the bottle.
D) Administer the medication if the name of the drug can be clearly read

Answer 20

A

When the drug label is soiled obscuring some information the safest action by the nurse is to discard the
bottle and contents because drug labels contain a great deal of important information, far more than just
the name of the drug

Question 21

The nurse, providing patient teaching about home medication use to an older adult, explains that even
when drugs are taken properly they can produce negative or unexpected effects. What are these
negative or unexpected effects called?
A) Teratogenic effects
B) Toxic effects
C) Adverse effects
D) Therapeutic effects

Answer 21

C

Negative or unexpected effects are known as adverse or side effects

Question 22

After administering a medication, for what would the nurse assess the patient?
A) Drug effects
B) Allergies
C) Pregnancy
D) Preexisting conditions

Answer 22

A

After the medication is administered, the nurse assesses the patient for drug affects, both therapeutic
and adverse

Question 23

The nurse receives an order to administer an unfamiliar medication and obtains a nurse’s drug guide
published four years earlier. What is the nurse’s most prudent action?
A) Find a more recent reference source.
B) Use the guide if the drug is listed.
C) Ask another nurse for drug information.
D) Verify the information in the guide with the pharmacist

Answer 23

A

Question 24

In response to the patient’s question about how to know whether drugs are safe, the nurse explains that
all medications undergo rigorous scientific testing controlled by what organization?
A) Food and Drug Administration (FDA)
B) Drug Enforcement Agency (DEA)
C) Centers for Disease Control and Prevention (CDC)
D) Joint Commission on Accreditation of Healthcare Organizations (JCAHO)

Answer 24

A

Question 25

The nurse, assisting with Phase I drug studies, is talking with a woman who asks, Why can’t I
participate in this study? What would be the nurse’s best response?
A) Drugs pose a greater risk to women of reproductive age.
B) Drugs are only tested on men because they are stronger.
C) Women are more prone to adverse effects from medications.
D) Drugs affect women differently than they affect women

Answer 25

A

Phase I drug trials usually involve healthy male volunteers because chemicals may exert an unknown
and harmful effect on ova in women which could result in fetal damage when the woman becomes
pregnant.

Question 26

The telephone triage nurse receives a call from a patient asking for a prescription for a narcotic to
manage his surgical pain. The nurse explains that narcotic prescriptions must be written and cannot be
called in to the pharmacy. The patient says, Why are narcotics so difficult to get a prescription for?
What is the nurse’s best response?
A) The Drug Enforcement Agency (DEA) determines the risk for addiction and the Food and Drug
Administration (FDA) enforces their control.
B) The increase in the number of drug addicts has made the rules stronger.
C) The Centers for Disease Control and Prevention (CDC) regulates use of controlled substances to
reduce the risk of injury.
D) Controlled substances like narcotics are controlled by the FDA and the DEA

Answer 26

D

Question 27

The nurse explains the Drug Enforcement Agency’s (DEA’s) schedule of controlled substances to the
nursing assistant who asks, Do you ever get a prescription for Schedule I medications? What is the
nurse’s best response?
A) Schedule I medications have no medical use so they are not prescribed
B) Schedule I medications have the lowest risk for abuse and do not require a prescription.
C) Schedule I medications are only prescribed in monitored units for patient safety.
D) Schedule I medications are found in antitussives and antidiarrheals sold over the counter

Answer 27

A

Question 28

The patient is prescribed a medication that was just placed in Phase IV study. The patient tells the
nurse, This medication is too expensive. Could the doctor order a generic form of this medication?
What is the nurse’s most accurate response?
A) Medications are not produced in generic form until the patent expires, which normally takes
several years.
B) You can request the generic form but the binder used may make the drug less effective for this
medication.
C) The generic form of the medication would not be any less expensive because this is a relatively
new medication.
D) Generic medications are lower quality drugs and that would mean you would not be getting the
best treatment available

Answer 28

a

When a new drug enters the market, it is given a time-limited patent; generic forms of the medication
cannot be produced until the patent expires. Because no generic version of this drug will exist because
it is so new, it is impossible to predict what binder will be used or what the cost would be

Question 29

Before administering a prescription medication, what information does the nurse find on the drug label?
(Select all that apply.)
A) Brand name
B) Generic name
C) Drug concentration
D) Expiration date
E) Adverse effect

Answer 29

A, B, C, D

Prescription drug labels will contain the brand name, generic name, drug concentration, and expiration
date

Question 30

The nurse is preparing a medication that is new to the market and cannot be found in the nurse’s drug
guide. Where can the nurse get the most reliable information about this medication?
A) Package insert
B) Another nurse
C) Drug manufacturer
D) Physician

Answer 30

A

Question 31

Drugs do not metabolize the same way in all people. For what patient would a nurse expect to assess
for an alteration in drug metabolism?
A) A 35-year-old woman with cervical cancer
B) A 41-year-old man with kidney stones
C) A 50-year-old man with cirrhosis of the liver
D) A 62-year-old woman in acute renal failure

Answer 31

C

The liver is the most important site of drug metabolism. If the liver is not functioning effectively

Question 32

An important concept taught by the nurse when providing medication teaching is the need to provide a
complete list of medications taken to health care providers to avoid what?

A) Spending large amounts of money on medications
B) Allergic reactions to medications
C) Drugdrug interactions
D) Critical concentrations of medications in the body

Answer 32

C

It is important that all health care providers have a complete list of the patient’s medications to avoid
drugdrug interactions caused by one provider ordering a medication, unaware of another medication the patient is taking that could interact with the new prescription.

Question 33

A pharmacology student asks the instructor what an accurate description of a drug agonist is. What is
the instructor’s best response?

A) A drug that reacts with a receptor site on a cell preventing a reaction with another chemical on a
different receptor site
B) A drug that interferes with the enzyme systems that act as catalyst for different chemical reactions
C) A drug that interacts directly with receptor sites to cause the same activity that a natural chemical
would cause at that site
D) A drug that reacts with receptor sites to block normal stimulation, producing no effec

Answer 33

C

Agonists are drugs that produce effects similar to those produced by naturally occurring
neurotransmitters, hormones, or other substances found in the body.

Question 34

A nurse is caring for a patient who has been receiving a drug by the intramuscular route but will receive
the drug orally after discharge. How does the nurse explain the increased dosage prescribed for the oral
dose?
A) Passive diffusion
B) Active transport
C) Glomerular filtration
D) First-pass effect

Answer 34

D

The first-pass effect involves drugs that are absorbed from the small intestine directly into the portal
venous system, which delivers the drug molecules to the liver.

Question 35

A nurse is caring for a patient who is supposed to receive two drugs at the same time. What is the
nurse’s priority action?
A) Wash her hands before handling the medications.
B) Consult a drug guide for compatibility.
C) Question the patient concerning drug allergies.
D) Identify the patient by checking the armband and asking the patient to state his name

Answer 35

B

Question 36

The nurse is talking with a group of nursing students who are doing clinical hours on the unit. A student
asks if all intramuscular (IM) drugs are absorbed the same. What factor would the floor nurse tell the
students to affect absorption of the IM administration of drugs?
A) Perfusion of blood to the subcutaneous tissue
B) Integrity of the mucous membranes
C) Environmental temperature
D) Blood flow to the gastrointestinal tract

Answer 36

C

A cold environmental temperature can cause blood vessels to vasoconstrict and decreases absorption or
in a hot environment vasodilate and increase absorption of IM medications

Question 37

The patient is taking a drug that affects the body by increasing cellular activity. Where does this drug
work on the cell?
A) Receptor sites
B) Cell membrane
C) Golgi body
D) Endoplasmic reticulum

Answer 37

A

Many drugs are thought to act at specific areas on cell membranes called receptor sites

Question 38

Several processes enable a drug to reach a specific concentration in the body. Together they are called
dynamic equilibrium. What are these processes? (Select all that apply.)
A) Distribution to the active site
B) Biotransformation
C) Absorption from the muscle
D) Excretion
E) Interaction with other drugs

Answer 38

ABD

The actual concentration that a drug reaches in the body results from a dynamic equilibrium involving
several processes: Absorption from the site of entry (can be from the muscle, the gastrointestinal (GI)
tract if taken orally, of the subcutaneous tissue if given by that route); Distribution to the active site;
biotransformation (metabolism) in the liver; excretion from the body. Interaction with other drugs is not
part of the dynamic equilibrium.

Question 39

13. A nurse is administering digoxin to a patient. To administer medications so that the drug is as effective as possible, the nurse needs to consider what?

A) Pharmacotherapeutics
B) Pharmacokinetics
C) Pharmacoeconomics
D) Pharmacogenomics

Answer 39

B

Question 40

The nurse is explaining how medications work to a group of peers and explains that disruption of a
single step in any enzyme system disrupts what?
A) Cell life
B) Cell membrane
C) Cell receptor sites
D) Cell function

Answer 40

D

Question 41

The processes involved in dynamic equilibrium are key elements in the nurse’s ability to determine
what?
A) Dosage scheduling
B) Amount of solution for mixing parenteral drugs
C) Timing of other drugs the patient is taking
D) How long the patient has to take the drug

Answer 41

A
These processes are key elements in determining the amount of drug (dose) and the frequency of dose
repetition (scheduling) required to achieve the critical concentration for the desired length of time. The
processes in dynamic equilibrium are not key elements in determining the amount of diluents for
intramuscular (IM) drugs; they do not aid in the timing of the other drugs the patient is taking or how
long the patient has to take the drug

Question 42

What factor influences drug absorption?
A) Kidney function
B) Route of administration
C) Liver function
D) Cardiovascular function

Answer 42

B

Drug absorption is influenced by the route of administration. IV administration is the fastest method;
drug absorption is slower when given orally. Kidney function impacts excretion, liver function impacts
metabolism, and cardiovascular function impacts distribution.

Question 43

What does the lipid solubility of the drug influence?
A) Absorption of the drug
B) Metabolism of the drug
C) Excretion of the drug
D) Distribution of the drug

Answer 43

D

Factors that can affect distribution include the drug’s lipid solubility and ionization and the perfusion of
the reactive tissue. The lipid solubility of a drug does not influence absorption, metabolism, or
excretion.

Question 44

The nursing students are learning about the half-life of drugs. A student asks the instructor to explain
half-life. What is the instructor’s best response?

A) Half-life of a drug is the time it takes for the amount of drug in the body to decrease to half of the
peak level it previously achieved.
B) Half-life is the amount of time it takes for the drug to be metabolized by the body.
C) Half-life is the amount of time it takes for half of the drug to reach peak level in the body.
D) Half-life of a drug is the time it takes for the drug to reach half its potential peak level in the body

Answer 44

A

The half-life of a drug is the time it takes for the amount of drug in the body to decrease to half the peak
level it previously achieved

Question 45

The patient is taking a 2-mg dose of ropinerol XR. The drug has a half-life of 12 hours. How long will
it be before only 0.25 mg of this drug remains in the patient’s system?

A) 24 hours
B) 36 hours
C) 48 hours
D) 60 hours

Answer 45

B

The half-life of a drug is the time it takes for the amount of drug in the body to decrease to half of the
peak level it previously achieved. At 12 hours there will be 1 mg of the drug available to the body. At
24 hours there will be 0.5 mg; at 36 hours there will be 0.25 mg; at 48 hours there will be 0.125 mg,
and at 60 hours there will be 0.0625 mg

Question 46

The patient has a diagnosis of multiple sclerosis and is taking the drug interferon beta-1a (Rebif). The
patient takes this drug by subcutaneous injection three times a week. The dosage is 44 mcg per
injection. If the patient takes an injection on Monday, how much of the drug would still be in the
patient’s system when she takes her next injection on Wednesday, assuming the half-life of the drug is
24 hours?

A) 22 mcg
B) 16.5 mcg
C) 11 mcg
D) 5.5 mcg

Answer 46

C

The half-life of a drug is the time it takes for the amount of drug in the body to decrease to 1 half the
peak level it previously achieved. O

Question 47

The patient is a 6-year-old child who is taking 125 mg of amoxicillin every 6 hours. Assuming that the
half-life of Amoxicillin is 3 hours, how much Amoxicillin would be in the child’s body at the time of
the next administration of the drug?

A) 62.5 mg
B) 46.875 mg
C) 31.25 mg
D) 15.625 mg

Answer 47

C

The half-life of a drug is the time it takes for the amount of drug in the body to decrease to 1 half the
peak level it previously achieved

Question 48

A drug with a half-life of 4 hours is administered at a dosage of 100 mg. How much of the drug will be
in the patient’s system 8 hours after administration?
A) 75 mg
B) 50 mg
C) 37.5 mg
D) 25 mg

Answer 48

D

The half-life of a drug is the time it takes for the amount of drug in the body to decrease to 1 half the
peak level it previously achieved.

Question 49

The nurse administers amoxicillin 500 mg. The half-life of this drug is approximately 1 hour. At what
point would the drug level in the body be 62.5 mg if the drug was not administered again?
A) 1 hours after the original dose
B) 2 hours after the original dose
C) 3 hours after the original dose
D) 4 hours after the original dose

Answer 49

C

The half-life of a drug is the time it takes for the amount of drug in the body to decrease to one-half of
the peak level it previously achieved

Question 50

The nurse is caring for a patient who is receiving gentamicin, 250 mg and fluconazole (Diflucan), 500
mg at the same time. The nurse knows that if these two drugs competed with each other for proteinbinding sites, what would this do?

A) Make the patient gentamicin deficient
B) Make the patient fluconazole deficient
C) Counteract any positive benefit the drugs would have
D) Alter the effectiveness of both drugs

Answer 50

D

Some drugs compete with each other for protein-binding sites, altering effectiveness or causing toxicity
when the two drugs are given together

Question 51

The student nurse asks the instructor why a patient with a central nervous system infection is receiving
antibiotics that will not cross the bloodbrain barrier. What is the instructor’s most correct response?

A) A severe infection alters the bloodbrain barrier to allow the drug to cross.
B) A medication that is water soluble is more likely to cross the blood-brain barrier.
C) Antibiotics are the exception to the bloodbrain barrier and cross easily.
D) An infection that spreads outside the central nervous system helps drugs cross the barrier.

Answer 51

A

Effective antibiotic treatment can occur only when the infection is severe enough to alter the bloodbrain
barrier and allow antibiotics to cross. L

Question 52

The patient is taking low dose aspirin daily for his heart. The nurse knows only a portion of the
medication taken actually reaches the tissue due to what process?

A) Distribution
B) First-pass effect
C) Reduced absorption
D) Gastrointestinal circulation

Answer 52

B

Drugs that are taken orally are usually absorbed from the small intestine directly into the portal venous
system and then delivers these absorbed molecules into the liver, which immediately break the drug
into metabolites, some of which are active and cause effects in the body, and some of which are
deactivated and can be readily excreted from the body. As a result, a large percentage of the oral dose is
destroyed at this point and never reaches the tissues. This process is not caused by distribution,
absorption, or gastrointestinal circulation

Question 53

What needs to happen to the proteindrug complex for the drugs to reach the cells where the drug can
act?
A) The proteindrug complex must break itself into smaller pieces to enter the capillaries.
B) The binding site on the protein picks up a chemical to make it soluble in the serum.
C) The drug must break away from the protein-binding site and float freely.
D) The drug must be dissolved in the plasma so it can enter the capillaries and then the tissues.

Answer 53

C

Most drugs are bound, to some extent, to proteins in the blood to be carried into circulation. The
proteindrug complex is relatively large and cannot enter into capillaries and then into tissues to react.
The drug must be freed from the protein’s binding site at the tissues. This occurs without the
introduction of another chemical or by dissolving in it plasma

Question 54

The nurse is reviewing the results of the patient’s laboratory tests. What must the nurse keep in mind
when reviewing these results related to medication administration?
A) The patient’s emotional response to the disease process
B) The timing of the last dose of medication relative to when blood was drawn
C) The possibility of a druglaboratory test interaction
D) A change in the body’s responses or actions related to the drug

Answer 54

C

Question 55

A patient has come to the clinic and been diagnosed with Lyme disease. The physician has ordered oral
tetracycline. What is important for the nurse to include in the teaching plan about tetracycline? (Select
all that apply.)

A) Do not take the drug with anything high in sodium content to keep from producing a state of
hypernatremia in the body.
B) Do not take the drug with foods or other drugs that contain calcium.
C) Do not take the drug at the same time you take an iron supplement or with foods that are high in
iron content.
D) Avoid exposure to the sun when taking this drug as it can turn your skin purple.
E) Avoid eating bananas at the same time you take this drug as the potassium content of the
tetracycline can produce hyperkalemia in the body

Answer 55

BC

The antibiotic tetracycline is not absorbed from the gastrointestinal (GI) tract if calcium or calcium
products (e.g., milk) are present in the stomach. It cannot be taken with iron products because a
chemical reaction occurs preventing absorption. Although tetracycline can increase sun sensitivity, it
does not turn the skin purple. Patients who take tetracycline do not need to avoid eating bananas or
foods that are high in potassium

Question 56

30. A nurse is caring for a patient taking multiple drugs and is concerned about a possible drugdrug
    interaction. What is the nurse’s first and best means of avoiding this problem?
    A) Consult a drug guide.
    B) Call the pharmacist.
    C) Contact the provider.
    D) Ask another nurse

Answer 56

A

Whenever two or more drugs are being given together, first consult a drug guide for a listing of
clinically significant drugdrug interactions

Question 57

The nurse promotes optimal drug effectiveness by doing what? (Select all that apply.)
A) Incorporate basic history and physical assessment factors into the plan of care.
B) Evaluate the effectiveness of drugs after they have been administered.
C) Modify the drug regimen to modify adverse or intolerable effects.
D) Minimize the number of medications administered to patients.
E) Examine factors known to influence specific drugs if they are to be effective.

Answer 57

ABCE

Question 58

The nurse administers a specific medication to an older adult patient every 4 hours. The patient has a
history of chronic renal failure. Why would this patient be at risk for toxic drug levels?
A) Cumulative effect
B) First-pass effect
C) Drug interactions
D) Cross-tolerance effect

Answer 58

A

If a drug is taken in successive doses at intervals that are shorter than recommended, or if the body is
unable to eliminate a drug properly, the drug can accumulate in the body, leading to toxic levels and
adverse effects. This is a cumulative effect.

Question 59

The patient, diagnosed with cancer, is receiving morphine sulfate (a potent narcotic pain reliever) to
relieve cancer pain. Approximately every 7 days the medication is no longer effective in controlling the
patient’s pain and a larger dose is needed to have the same effect. How might the nurse explain why
this is happening?
A) Tolerance
B) Cumulation
C) Interactions
D) Addiction

Answer 59

A

Question 60

While administering a medication that the nurse has researched and found to have limited effectiveness,
the patient tells the nurse, I have read all about this drug and it is such a wonder drug. I’m so lucky my
doctor prescribed it because I just know it will treat my problem. The nurse suspects this drug will be
more effective than usual for this patient because of what effect?
A) Cumulative effect
B) First-pass effect
C) Placebo effect
D) Cross-tolerance effect

Answer 60

C

A drug is more likely to be effective if the patient thinks it will work than if the patient believes it will
not work. This is called the placebo effect

Question 61

The nurse administers an intravenous medication with a half-life of 24 hours but recognizes what
factors in this patient could extend the drug’s half-life? (Select all that apply.)
A) Gastrointestinal disease
B) Kidney disease
C) Liver disease
D) Cardiovascular disease
E) Route of administration

Answer 61

BCD

Kidney disease could slow excretion and extend the drug’s half-life. Liver disease could slow
metabolism resulting in an extended half-life. Cardiovascular disease could slow distribution resulting
in a longer half-life. Gastrointestinal disease would not impact half-life because the medication was
injected directly into the bloodstream. Route of administration would not extend half-life because IV
injection eliminates the absorption step in the process.