Pharmacology Test Bank: Multiple Choice Questions and Answers, Exams of Pharmacology

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ASSESSED PHARMACOLOGY

TEST BANK

The nurse is teaching a patient how a medication works to treat an illness. To do this, the nurse will rely on knowledge of:

a. clinical pharmacology.

b. drug efficacy.

c. pharmacokinetics.

d. pharmacotherapeutics. - CORRECT ANSWER -ANS: D

Pharmacotherapeutics is the study of the use of drugs to diagnose, treat, and prevent conditions. Clinical pharmacology is concerned with all aspects of drug-human interactions. Drug efficacy measures the extent to which a given drug causes an intended effect. Pharmacokinetics is the study of the impact of the body on a drug.

What does it mean when a drug is described as easy to administer?

a. It can be stored indefinitely without need for refrigeration.

b. It does not interact significantly with other medications.

c. It enhances patient adherence to the drug regimen.

d. It is usually relatively inexpensive to produce. - CORRECT ANSWER -ANS: C

A major benefit of drugs that are easy to administer is that patients taking them are more likely to comply with the drug regimen. Drugs that are easy to give may have the other attributes listed, but those properties are independent of ease of administration.

A patient tells the nurse that he was told by the prescriber that the analgesic he is taking is very effective. Which statement by the patient demonstrates an understanding of the drug's effectiveness?

a. "I don't have to worry about toxicity, since it takes a large amount of this drug to cause an overdose."

b. "It has no side effects and doesn't interact with other drugs."

c. "I only have to take it every 12 hours."

d. "It might make me sleepy, and it lessens pain for several hours at a time." - CORRECT ANSWER -ANS: D

A drug is effective if it produces the intended effects, even if it also produces side effects. Because no drug is completely safe, the level of toxicity does not determine effectiveness. All drugs have side effects and many react with other substances; these do not affect the drug's effectiveness. Ease of administration is independent of a drug's effectiveness.

What are the properties of an ideal drug? (Select all that apply.)

a. Irreversible action

b. Predictability

c. Ease of administration

d. Chemical stability

e. A simple trade name - CORRECT ANSWER -ANS: B, C, D

In addition to predictability, ease of administration, and chemical stability, other properties include a reversible action so that any harm the drug may cause can be undone and a simple generic name, because generic names are usually complex and difficult to remember and pronounce.

Before administering a medication, what does the nurse need to know to evaluate how individual patient variability might affect the patient's response to the medication? (Select all that apply.)

A postoperative patient is being discharged home with acetaminophen/hydrocodone (Lortab) for pain. The patient asks the nurse about using Tylenol for fever. Which statement by the nurse is correct?

a. "It is not safe to take over-the-counter drugs with prescription medications."

b. "Taking the two medications together poses a risk of drug toxicity."

c. "There are no known drug interactions, so this will be safe."

d. "Tylenol and Lortab are different drugs, so there is no risk of overdose." - CORRECT ANSWER -ANS: B

Tylenol is the trade name and acetaminophen is the generic name for the same medication. It is important to teach patients to be aware of the different names for the same drug to minimize the risk of overdose. Over-the-counter (OTC) medications and prescription medications may be taken together unless significant harmful drug interactions are possible. Even though no drug interactions are at play in this case, both drugs contain acetaminophen, which could lead to toxicity.

The nurse is preparing to care for a patient who will be taking an antihypertensive medication. Which action by the nurse is part of the assessment step of the nursing process?

a. Asking the prescriber for an order to monitor serum drug levels

b. Monitoring the patient for drug interactions after giving the medication

c. Questioning the patient about over-the-counter medications

d. Taking the patient's blood pressure throughout the course of treatment - CORRECT ANSWER -ANS: C

The assessment part of the nursing process involves gathering information before beginning treatment, and this includes asking about other medications the patient may be taking. Monitoring serum drug levels, watching for drug interactions, and checking vital signs after giving the medication are all part of the evaluation phase.

A postoperative patient reports pain, which the patient rates as an 8 on a scale from 1 to 10 (10 being the most extreme pain). The prescriber has ordered acetaminophen (Tylenol) 650 mg PO every 6 hours PRN pain. What will the nurse do?

a. Ask the patient what medications have helped with pain in the past.

b. Contact the provider to request a different analgesic medication.

c. Give the pain medication and reposition the patient to promote comfort.

d. Request an order to administer the medication every 4 hours. - CORRECT ANSWER -ANS: B

The nursing diagnosis for this patient is severe pain. Acetaminophen is given for mild to moderate pain, so the nurse should ask the prescriber to order a stronger analgesic medication. Asking the patient to tell the nurse what has helped in the past is a part of an initial assessment and should be done preoperatively and not when the patient is having severe pain. Because the patient is having severe pain, acetaminophen combined with nondrug therapies will not be sufficient. Increasing the frequency of the dose of a medication for mild pain will not be effective.

A patient newly diagnosed with diabetes is to be discharged from the hospital. The nurse teaching this patient about home management should begin by doing what?

a. Asking the patient to demonstrate how to measure and administer insulin

b. Discussing methods of storing insulin and discarding syringes

c. Giving information about how diet and exercise affect insulin requirements

d. Teaching the patient about the long-term consequences of poor diabetes control - CORRECT ANSWER -ANS: A

Because insulin must be given correctly to control symptoms and because an overdose can be fatal, it is most important for the patient to know how to administer it. Asking for a demonstration of technique is the best way to determine whether the patient has understood the teaching. When a patient is receiving a lot of new information, the information presented first is the most likely to be remembered. The other teaching points are important as well, but they are not as critical and can be taught later.

The nurse receives an order to give morphine 5 mg IV every 2 hours PRN pain. Which action is not part of the six rights of drug administration?

a. A 30-year-old man with kidney disease

b. A 75-year-old woman with cystitis

c. A 50-year-old man with an upper respiratory tract infection

d. A 9-year-old boy with an ear infection - CORRECT ANSWER -ANS: A

The individual with impaired kidney function would be at risk of having the drug accumulate to a toxic level because of potential excretion difficulties. Cystitis is an infection of the bladder and not usually the cause of excretion problems that might lead to an adverse reaction from a medication. A respiratory tract infection would not predispose a patient to an adverse reaction, because drugs are not metabolized or excreted by the lungs. A 9-year-old boy would not have the greatest predisposition to an adverse reaction simply because he is a child; nor does an ear infection put him at greater risk.

A nurse consults a drug manual before giving a medication to an 80-year-old patient. The manual states that elderly patients are at increased risk for hepatic side effects. Which action by the nurse is correct?

a. Contact the provider to discuss an order for pretreatment laboratory work.

b. Ensure that the drug is given in the correct dose at the correct time to minimize the risk of adverse effects.

c. Notify the provider that this drug is contraindicated for this patient.

d. Request an order to give the medication intravenously so that the drug does not pass through the liver. - CORRECT ANSWER -ANS: A

The drug manual indicates that this drug should be given with caution to elderly patients. Getting information about liver function before giving the drug establishes baseline data that can be compared with post-treatment data to determine whether the drug is affecting the liver. Giving the correct dose at the correct interval helps to minimize risk, but without baseline information, the effects cannot be determined. The drug is not contraindicated.

A patient has been receiving intravenous penicillin for pneumonia for several days and begins to complain of generalized itching. The nurse auscultates bilateral wheezing and notes a temperature of 38.5° C (101° F). Which is the correct action by the nurse?

a. Administer the next dose and continue to evaluate the patient's symptoms.

b. Ask the prescriber if an antihistamine can be given to relieve the itching.

c. Contact the prescriber to request an order for a chest radiograph.

d. Hold the next dose and notify the prescriber of the symptoms. - CORRECT ANSWER -ANS: D

Pruritus and wheezing are signs of a possible allergic reaction, which can be fatal; therefore, the medication should not be given and the prescriber should be notified. When patients are having a potentially serious reaction to a medication, the nurse should not continue giving the medication. Antihistamines may help the symptoms of an allergic reaction, but the first priority is to stop the medication. Obtaining a chest radiograph is not helpful.

A nurse is reviewing a patient's medical record before administering a medication. Which factor(s) can alter the patient's physiologic response to the drug? (Select all that apply.)

a. Ability to swallow pills

b. Age

c. Genetic factors

d. Gender

e. Height - CORRECT ANSWER -ANS: B, C, D

Age, genetic factors, and gender all influence an individual patient's ability to absorb, metabolize, and excrete drugs; therefore, these factors must be assessed before a medication is administered. A patient's ability to swallow pills, although it may determine the way a drug is administered, does not affect the physiologic response. Height does not affect response; weight and the distribution of adipose tissue can affect the distribution of drugs.

a. ensure that differences in outcomes are the result of treatment and not differences in subjects.

b. compare the outcome caused by the treatment to the outcome caused by no treatment.

c. make sure that researchers are unaware of which subjects are in which group.

d. prevent subjects from knowing which group they are in and prevent preconception bias. - CORRECT ANSWER -ANS: A

Randomization helps prevent allocation bias, which can occur when researchers place subjects with desired characteristics in the study group and other subjects in the control group so that differences in outcome are actually the result of differences in subjects and not treatment. Comparing treatment outcome to no treatment outcome is the definition of a controlled study. The last two options describe the use of blinding in studies; blinding ensures that researchers or subjects (or both) are unaware of which subjects are in which group so that preconceptions about benefits and risks cannot bias the results.

Someone asks a nurse about a new drug that is in preclinical testing and wants to know why it cannot be used to treat a friend's illness. Which statement by the nurse is correct?

a. "A drug at this stage of development can be used only in patients with serious disease."

b. "At this stage of drug development, the safety and usefulness of the medication is unknown."

c. "Clinical trials must be completed to make sure the drug is safe to use in humans."

d. "Until postmarketing surveillance data are available, the drug cannot be used." - CORRECT ANSWER - ANS: B

Preclinical testing must be completed before drugs can be tested in humans. In this stage, drugs are evaluated for toxicities, pharmacokinetic properties, and potentially useful effects. Some drugs can be used in patients before completion of Phase III studies, but this is after preclinical testing is complete. Clinical trials proceed in stages, and each stage has guidelines defining how a new drug may be used and which patients may receive it. Postmarketing surveillance takes place after a drug is in general use.

A patient asks a nurse why drugs that have been approved by the FDA still have unknown side effects. The nurse tell the patient that:

a. testing for all side effects of a medication would be prohibitively expensive.

b. patients in drug trials often are biased by their preconceptions of a drug's benefits.

c. researchers tend to conduct studies that will prove the benefits of their new drugs.

d. subjects in drug trials do not always represent the full spectrum of possible patients. - CORRECT ANSWER -ANS: D

All drug trials are limited by a relatively small group of subjects who may not have all the characteristics of people who will be using the drug; therefore, some side effects go undetected until the drug is in use. Although drug trials are very expensive, this is only an indirect reason they do not detect all side effects before approval. In theory, well-designed drug trials, using blinded studies, minimize or eliminate subject bias. Designing studies to prove desired results is unethical.

A nurse is teaching nursing students about the use of nonproprietary names for drugs. The nurse tells them which fact about nonproprietary names?

a. They are approved by the FDA and are easy to remember.

b. They are assigned by the U.S. Adopted Names Council.

c. They clearly identify the drug's pharmacological classification.

d. They imply the efficacy of the drug and are less complex. - CORRECT ANSWER -ANS: B

Nonproprietary, or generic, names are assigned by the U.S. Adopted Names Council, which ensures that each drug has only one name. Trade names, or brand names, are approved by the FDA and are easier to remember. Some nonproprietary names contain syllables that identify the classification, although not all do. Drug names are not supposed to identify the use for the drug, although some brand names do so.

A patient tells the nurse that the oral drug that has been prescribed has caused a lot of stomach discomfort in the past. What will the nurse ask the prescriber?

different rates and affect the bioavailability of the drug. Two brands may be chemically equivalent and still differ in bioavailability, which is not determined by the amount of drug in the dose.

A patient receives a drug that has a narrow therapeutic range. The nurse administering this medication will expect to do what?

a. Administer the drug at intervals longer than the drug half-life.

b. Administer this medication intravenously.

c. Monitor plasma drug levels.

d. Teach the patient that maximum drug effects will occur within a short period. - CORRECT ANSWER - ANS: C

A drug with a narrow therapeutic range is more difficult to administer safely, because the difference between the minimum effective concentration and the toxic concentration is small. Patients taking these medications must have their plasma drug levels monitored closely to ensure that they are getting an effective dose that is not toxic. Administering medications at longer intervals only increases the time required to reach effective plasma drug levels. Drugs that have a narrow therapeutic range may be given by any route and do not differ from other medications in the amount of time it takes to take effect, which is a function of a drug's half-life and dosing frequency.

A patient is given a prescription for azithromycin (Zithromax) and asks the nurse why the dose on the first day is twice the amount of the dose on the next 4 days. Which reply by the nurse is correct?

a. "A large initial dose helps to get the drug to optimal levels in the body faster."

b. "The first dose is larger to minimize the first pass effect of the liver."

c. "The four smaller doses help the body taper the amount of drug more gradually."

d. "Tubular reabsorption is faster with initial doses, so more is needed at first." - CORRECT ANSWER - ANS: A

A large initial dose is often used as a loading dose to help get serum drug levels to plateau levels more quickly. Larger doses do not prevent first pass effects in drugs susceptible to this type of metabolism. Tapering of doses sometimes is used to prevent rebound or withdrawal effects and is done by stepping down the amount of drug with each dose. Tubular reabsorption is a process that allows drugs to be reabsorbed from the urine into the blood.

A nurse is giving an enteral medication. The patient asks why this method is preferable for this drug. How will the nurse reply?

a. "This route allows more rapid absorption of the drug."

b. "This route is safer, less expensive, and more convenient."

c. "This route is the best way to control serum drug levels."

d. "This route prevents inactivation of the drug by digestive enzymes." - CORRECT ANSWER -ANS: B

Parenteral routes include the intravenous, intramuscular, and subcutaneous routes. Enteral routes include oral administration, including pills and liquid suspensions. Enteral routes are safer, cheaper, and easier to use. Parenteral routes are used when rapid absorption, precise control of plasma drug levels, and prevention of digestive inactivation are important.

The nurse is preparing to administer penicillin G intramuscularly to a child. The child's parents ask why the drug cannot be given in an oral liquid form. What is the nurse's reply?

a. "This drug causes severe gastric upset if given orally."

b. "This drug has a narrow therapeutic range, and the dose must be tightly controlled."

c. "This drug is absorbed much too quickly in an oral form."

d. "This drug would be inactivated by enzymes in the stomach." - CORRECT ANSWER -ANS: D

Penicillin G is inactivated by digestive enzymes in the stomach and cannot be given orally. It does not have a narrow therapeutic range.

A nurse is explaining drug metabolism to a nursing student who asks about glucuronidation. The nurse knows that this is a process that allows drugs to be:

a. excreted in hydrolyzed form in the feces to reduce drug toxicity.

b. reabsorbed from the urine into the renal circulation to minimize drug loss.

c. recycled via the enterohepatic recirculation to remain in the body longer.

d. transported across the renal tubules to be excreted in the urine. - CORRECT ANSWER -ANS: C

Glucuronidation of some drugs in the liver allows drugs to enter the bile, pass into the duodenum, and then be hydrolyzed to release the free drug. This is a repeating cycle of enterohepatic recirculation, which allows drugs to remain in the body longer. Glucuronidated drugs that are more resistant to hydrolysis are excreted in the feces. Glucuronidation occurs in the enterohepatic circulation and not in the renal circulation.

A patient is receiving intravenous gentamicin. A serum drug test reveals toxic levels. The dosing is correct, and this medication has been tolerated by this patient in the past. Which could be a probable cause of the test result?

a. A loading dose was not given.

b. The drug was not completely dissolved in the IV solution.

c. The patient is taking another medication that binds to serum albumin.

d. The medication is being given at a frequency that is longer than its half-life. - CORRECT ANSWER - ANS: C

Gentamicin binds to albumin, but only weakly and, in the presence of another drug that binds to albumin, can rise to toxic levels in blood serum. A loading dose increases the initial amount of a drug and is used to bring drug levels to the desired plateau more quickly. A drug that is not completely dissolved carries a risk of causing embolism. A drug given at a frequency longer than the drug half-life will likely be at subtherapeutic levels and not at toxic levels.

When administering medications to infants, it is important to remember which of the following? (Select all that apply.)

a. Breast-feeding infants are more likely to develop toxicity when given lipid-soluble drugs.

b. Immaturity of renal function in infancy causes infants to excrete drugs less efficiently.

c. Infants have immature livers, which slows drug metabolism.

d. Infants are more sensitive to medications that act on the central nervous system (CNS).

e. Oral medications are contraindicated in infants, because PO administration requires a cooperative patient. - CORRECT ANSWER -ANS: B, C, D

Immature renal function causes infants to excrete drugs more slowly, and infants are at risk for toxicity until renal function is well developed. Infants' livers are not completely developed, and they are less able to metabolize drugs efficiently. Because the blood-brain barrier is not well developed in infants, caution must be used when administering CNS drugs. Lipid-soluble drugs may be excreted in breast milk if the mother is taking them, but breast-feeding does not affect medications given directly to the infant. Oral medications may be given safely to infants as long as they are awake and can swallow the drug.

A patient is receiving digoxin twice daily. When assessing the patient before giving a dose, the nurse counts a pulse of 60 beats per minute and learns that the patient is experiencing nausea. The nurse consults a drug manual and verifies that the ordered dose is correct. What will the nurse do?

a. Contact the prescriber to report the symptoms.

b. Delay the dose so the drug can clear from receptor sites.

c. Give the medication as ordered, because the dose is correct.

d. Request an antinausea medication from the prescriber. - CORRECT ANSWER -ANS: A

The symptoms indicate toxicity, and even though the dose is safe and effective in most cases, an individual patient may have toxic effects with a standard dose. The nurse should contact the prescriber to discuss the next steps. Delaying a dose without a change in order is not within the scope of practice for a nurse. The nurse should not give a dose of a medication when toxicity is suspected, because

A patient who is taking morphine for pain asks the nurse how a pain medication can also cause constipation. What does the nurse know about morphine?

a. It binds to different types of receptors in the body.

b. It can cause constipation in toxic doses.

c. It causes only one type of response, and the constipation is coincidental.

d. It is selective to receptors that regulate more than one body process. - CORRECT ANSWER -ANS: D

Morphine is a medication that is selective to receptor type that regulates more than one process. Because it is selective to receptor type, it does not bind to different types of receptors. Constipation is a normal side effect and is not significant for toxicity.

A patient asks why albuterol causes a feeling of jitteriness when it is used to treat wheezing. The nurse knows that albuterol is a beta-adrenergic agonist that acts on beta2 receptor sites to cause smooth muscle dilation in the bronchioles of the lungs, but that it also can sometimes act on beta1 receptor sites in skeletal muscles to cause tremors. To explain this to the patient, the nurse will rely on knowledge of:

a. drug selectivity.

b. modified occupancy theory.

c. relative potency.

d. reversible effects. - CORRECT ANSWER -ANS: A

The ability of a drug to be selective for receptor sites in a patient determines the types of effects it can have on the body. This drug can bind to two different types of receptors that cause different reactions. The modified occupancy theory addresses the strength of an attraction between a drug and a receptor and the drug's ability to activate the receptor. Relative potency describes the amount of drug needed to produce a specific effect. Most drugs remain bound to receptors permanently, causing the effects to be reversible.

Two nurses are discussing theories of drug-receptor interaction. Which statements are true regarding the affinity of a drug and its receptor? (Select all that apply.)

a. Affinity and intrinsic activity are dependent properties.

b. Affinity refers to the strength of the attraction between a drug and its receptor.

c. Drugs with high affinity are strongly attracted to their receptors.

d. Drugs with low affinity are strongly attracted to their receptors.

e. The affinity of a drug for its receptors is reflected in its potency. - CORRECT ANSWER -ANS: B, C, E

Affinity refers to the strength of the attraction between a drug and its receptor. Drugs with high affinity are strongly attracted to their receptors, and the affinity of a drug and its receptors is reflected in its potency. Affinity and intrinsic activity are independent properties. Drugs with low affinity are weakly attracted to their receptors.

Which drugs will not be affected by interpatient variability? (Select all that apply.)

a. Antiseptics applied to the skin to slow bacterial growth

b. Antacids to help with the discomfort of heartburn

c. Broad-spectrum antibiotics that are effective against many organisms

d. Chelating agents that remove metal compounds from the body

e. Topical analgesics used to treat localized pain - CORRECT ANSWER -ANS: A, B, D

Antiseptics, antacids, and chelating agents are all receptorless drugs that do not depend on the body's processes for effects; these agents react with other molecules. Broad-spectrum antibiotics and topical analgesics bind with receptors to produce desired effects, and these processes can be influenced by individual patient variables.