Issuu

Chapter 1:Introduction to Drugs Format: Multiple Choice Chapter: 1 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 1 Page and Header: 3, Introduction 1. A nurse working in radiology administers iodine to a client who is having a computed tomography (CT) scan. The nurse working on the oncology unit administers chemotherapy to clients who have cancer. At the Public Health Department, a nurse administers a measles–mumps–rubella (MMR) vaccine to a 14-month-old child as a routine immunization. Which branch of pharmacology best describes the actions of all three nurses? A) pharmacoeconomics B) pharmacotherapeutics C) pharmacodynamics D) pharmacokinetics

Ans: B

Feedback: Pharmacology is the study of the biologic effects of chemicals. Nurses are involved with clinical pharmacology or pharmacotherapeutics, which is a branch of pharmacology that deals with the uses of drugs to treat, prevent, and diagnose disease. The radiology nurse is administering a drug to help diagnose a disease. The oncology nurse is administering a drug to help treat a disease. Pharmacoeconomics includes any costs involved in drug therapy. Pharmacodynamics involves how a drug affects the body, and pharmacokinetics is how the body acts on the body.

1 Document shared on https://www.docsity.com/en/test-bank-for-karch-s-focus-on-nursing-pharmacology-9th-edition-by-rebecca-tucker/10381517/

Format: Multiple Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 3 Page and Header: Legal Regulation of Drugs, 19, Box 1.2 2. The care provider has prescribed intravenous hydromorphone, an opioid, for a client using a client-controlled analgesia (PCA) pump. The nurse is aware that this drug has a high abuse potential. Under what category would hydromorphone be classified? A) schedule I B) schedule II C) schedule III D) shedule IV

Ans: B

Feedback: Opioids with a high abuse potential are classified as schedule II drugs because of severe dependence liability. Schedule I drugs have high abuse potential and no accepted medical use. Schedule III drugs have a lesser abuse potential than schedule II drugs and an accepted medical use. Schedule IV drugs have low abuse potential and limited dependence liability.

2 Document shared on https://www.docsity.com/en/test-bank-for-karch-s-focus-on-nursing-pharmacology-9th-edition-by-rebecca-tucker/10381517/

3. When involved in phase III drug evaluation studies, what action should the nurse perform? A) Work with animals which are given experimental drugs. B) Select appropriate clients to be involved in the drug study. C) Monitor and observe clients closely for adverse effects. D) Make decisions that will determine effectiveness of the drug.

Ans: C

Feedback: Phase III studies involve use of a drug in a larger sample of the population. The purpose is to determine the treatment benefit and to monitor side effects that may not have been apparent in the earlier studies. Phase I studies involve healthy human volunteers who are usually paid for their participation. Nurses may observe for adverse effects and toxicity. 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. Use of animals in drug testing is done in the preclinical trials. Select clients who are involved in phase II studies have the disease the drug is intended to treat. These clients are monitored closely for drug action and adverse effects.

Format: Multiple Choice Chapter: 1 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 4 Page and Header: 22, Legal Regulation of Drugs 4. What concept is prioritized when a provider is considering the substitution of brand name drug with a generic drug? A) bioequivalency B) critical concentration

3 Document shared on https://www.docsity.com/en/test-bank-for-karch-s-focus-on-nursing-pharmacology-9th-edition-by-rebecca-tucker/10381517/

C) distribution D) half-life

Ans: A

Feedback: The goal is that the generic medication is bioequivalent (has the same effect on the body) to the brand name medication. Binders used in a generic drug may not be the same as those used in the brand name drug. Therefore, the way the body breaks down and uses the drug may differ, which may eliminate a generic drug substitution. Critical concentration is the amount of a drug that is needed to cause a therapeutic effect and should not differ between generic and brand name medications. Distribution is the phase of pharmacokinetics, which involves the movement of a drug to the body’s tissues and is the same in generic and brand name drugs. A drug’s half-life is the time it takes for the amount of drug to decrease to half the peak level, which should not change when substituting a generic medication.

Format: Multiple Choice Chapter: 1 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 23, Legal Regulation of Drugs 5. A nurse is assessing the client’s home medication use. After listening to the client 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?”

Ans: D

4 Document shared on https://www.docsity.com/en/test-bank-for-karch-s-focus-on-nursing-pharmacology-9th-edition-by-rebecca-tucker/10381517/

Feedback: It is important for the nurse to specifically question use of over-the-counter medications because clients may not consider them important. The client is unlikely to know the meaning of “orphan drugs” unless they are a healthcare provider. Safety during pregnancy, use of a generic medication, or classification of orphan drugs are things the client would be unable to answer but could be found in reference books if the nurse wishes to research them.

Format: Multiple Choice Chapter: 1 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Easy Integrated Process: Teaching/Learning Objective: 2 Page and Header: 5, Introduction 6. What goal should a nurse set when beginning a course on pharmacology for nurses? A) At the completion of the course, the nurse will know everything necessary for safe and effective medication administration. B) At the completion of the course, the nurse will know current pharmacologic therapy and will not require ongoing education for 5 years. C) At the completion of the course, the nurse will know general drug information because the nurse can consult a drug guide for specific drug information. D) At the completion of the course, the nurse will understand each drug action that is associated with each classification of medication.

Ans: C

Feedback: After completing a pharmacology course, nurses will have general drug information needed for safe and effective medication administration but will need to consult a drug guide for specific drug information before administering any medication. Pharmacology is constantly changing, with new drugs entering the market and new uses

5 Document shared on https://www.docsity.com/en/test-bank-for-karch-s-focus-on-nursing-pharmacology-9th-edition-by-rebecca-tucker/10381517/

for existing drugs identified. Continuing education in pharmacology is essential to safe practice. Nurses tend to become familiar with the medications they administer most often, but there will always be a need to research new drugs and also those the nurse is not familiar with because no nurse knows all medications.

Format: Multiple Choice Chapter: 1 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2 Page and Header: 19, Safety During Pregnancy, Box 1.1 7. A nurse is instructing a pregnant client concerning the potential risk to their fetus from a pregnancy category D drug. What should the nurse inform the client? A) “Adequate studies in pregnant clients 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 clients.” C) “Animal studies have shown an adverse effect on the fetus, but there are no adequate studies in pregnant clients.” D) “There is evidence of human fetal risk, but the potential benefits from use of the drug may be acceptable despite potential risks.”

Ans: D

Feedback: Category A indicates that adequate studies in pregnant clients have not demonstrated a risk to the fetus in the first trimester or in later trimesters. Category B indicates that animal studies have not demonstrated a risk to the fetus. However, there have not been adequate studies in pregnant clients to demonstrate risk to a fetus during the first trimester of pregnancy and no evidence of risk in later trimesters. Category C indicates that animal studies have shown an adverse effect on the fetus, but no

6 Document shared on https://www.docsity.com/en/test-bank-for-karch-s-focus-on-nursing-pharmacology-9th-edition-by-rebecca-tucker/10381517/

adequate studies in humans. Category D reveals evidence of human fetal risk, but the potential benefits from the use of the drugs in pregnant clients may outweigh potential risks.

Format: Multiple Selection Chapter: 1 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Teaching/Learning Objective: 4 Page and Header: 23, Legal Regulation of Drugs 8. Discharge planning for clients leaving the hospital should include instructions on the use of over-the-counter (OTC) drugs. Which comments by the client should prompt the nurse to provide additional health education? Select all that apply. A) “OTC drugs are safe and do not cause adverse effects if taken properly.” B) “OTC drugs have been around for years and have not been tested by the Food and Drug Administration (FDA).” C) “OTC drugs are different from any drugs available by prescription and cost less.” D) “OTC drugs could cause serious harm if not taken according to directions.” E) “OTC drugs can often be used as a cost-effective substitute for prescribed drugs.”

Ans: A, B, C, E

Feedback: It is important to follow package directions because OTCs are medications that can cause serious harm if not taken properly. OTCs are drugs that have been determined to be safe when taken as directed; however, all drugs can produce adverse effects even when taken properly. They may have originally been prescription drugs that were tested by the FDA or they may have been grandfathered in when the FDA laws changed. OTC education should always be included as a part of the hospital discharge instructions. Client should not view OTC drugs as being substitutes for prescribed drugs.

7 Document shared on https://www.docsity.com/en/test-bank-for-karch-s-focus-on-nursing-pharmacology-9th-edition-by-rebecca-tucker/10381517/

Format: Multiple Choice Chapter: 1 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Easy Integrated Process: Teaching/Learning Objective: 4 Page and Header: 6, Introduction 9. A nurse is unfamiliar with a drug that a client in the community has recently been prescribed. What information source should the nurse consult? A) Drug Facts and Comparisons B) a nurse’s drug guide C) the website www.drugs.com D) the Physicians’ Drug Reference (PDR)

Ans: B

Feedback: A nurse’s drug guide provides nursing implications and client 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 Pocket Drug Guide for Nurses has drug monographs organized alphabetically and includes nursing implications and client teaching points. Numerous other drug handbooks are also on the market and readily available for nurses to use. Although other drug reference books such as Drug Facts and Comparisons and PDR can all provide essential drug information, they will not contain nursing implications and teaching points and can be more difficult to use than nurse’s drug guides. A reputable drug guide is a better source than a consumer website.

Format: Multiple Selection Chapter: 1 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand

8 Document shared on https://www.docsity.com/en/test-bank-for-karch-s-focus-on-nursing-pharmacology-9th-edition-by-rebecca-tucker/10381517/

Difficulty: Easy Integrated Process: Teaching/Learning Objective: 1 Page and Header: 5, Introduction 10. A nursing student is preparing to begin a pharmacology course. The student should anticipate what areas of study? Select all that apply. A) chemical pharmacology B) molecular pharmacology C) impact of drugs on the body D) the body’s response to a drug E) unexpected drug effects

Ans: C, D, E

Feedback: Nurses study pharmacology from a pharmacotherapeutic level, which includes the effect of drugs on the body, the body’s response to drugs, and both expected and unexpected drug effects. Chemical and molecular pharmacology are not included in nursing pharmacology courses.

Format: Multiple Choice Chapter: 1 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Easy Integrated Process: Teaching/Learning Objective: 1 Page and Header: 5, Introduction 11. The nurse is caring for an older adult who needs to know that drugs, even when taken correctly, can produce negative or unexpected effects. The nurse should address what topic during health education? A) teratogenic effects B) toxic effects C) adverse effects

9 Document shared on https://www.docsity.com/en/test-bank-for-karch-s-focus-on-nursing-pharmacology-9th-edition-by-rebecca-tucker/10381517/

D) paradoxical effects

Ans: C

Feedback: Negative or unexpected effects are known as adverse or side effects. Teratogenic effects are adverse effects on the fetus and not a likely concern for an older adult. Toxic effects occur when medication is taken in larger than recommended dosages caused by an increase in serum drug levels. Paradoxical effects are drug effects that are the opposite of what is intended.

Format: Multiple Choice Chapter: 1 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 1 Page and Header: 5, Introduction 12. The nurse has just administered a client’s medication. What action should the nurse perform next? A) Assess for drug effects. B) Perform a comprehensive health assessment. C) Educate the client about the purpose of the drug. D) Assess for preexisting conditions.

Ans: A

Feedback: After the medication is administered, the nurse assesses the client for drug effects, both therapeutic and adverse. The nurse would assess the client for allergies and preexisting conditions before administering a medication. Assessing for drug effects does not normally necessitate a comprehensive health assessment.

10 Document shared on https://www.docsity.com/en/test-bank-for-karch-s-focus-on-nursing-pharmacology-9th-edition-by-rebecca-tucker/10381517/

Format: Multiple Choice Chapter: 1 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 1 Page and Header: 6, Introduction 13. The nurse receives an order to administer an unfamiliar medication and obtains a nurse’s drug guide published 4 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) Use the guide because it is less than 6 years old. D) Verify the information in the guide with the pharmacist.

Ans: A

Feedback: The nurse is responsible for all medications administered and must find a recent reference source to ensure the information learned about the medication is correct and current. Using an older drug guide could be dangerous because it would not contain the most up-to-date information. Asking the pharmacist does not guarantee accurate information will be obtained and could harm the client if the information is wrong.

11 Document shared on https://www.docsity.com/en/test-bank-for-karch-s-focus-on-nursing-pharmacology-9th-edition-by-rebecca-tucker/10381517/

Page and Header: 5, Introduction 14. The nurse is preparing a client for discharge knowing the client will be selfadministering medication at home. What is the nurse’s most appropriate action? A) Provide the client with the nurse’s contact information for when the client has questions. B) Provide thorough medication teaching about drugs and the drug regimen. C) Advise the use of over-the-counter medications to use to treat potential adverse effects. D) Provide a 2-day supply of medication to take home until prescription is filled.

Ans: B

Feedback: The nurse is responsible for providing thorough medication teaching about drugs and the drug regimen to ensure the client knows how to take the medication and when to notify the provider. The nurse never provides personal contact information to a client. If adverse effects arise, the client is taught to call the healthcare provider and should not self-medicate with over-the-counter drugs, which could mask serious symptoms. The nurse never dispenses medication because it must be properly labeled for home use; this is done by the pharmacy.

Format: Multiple Choice Chapter: 1 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Easy Integrated Process: Communication and Documentation Objective: 2 Page and Header: 10, Drug Evaluation 15. In response to the client’s question about how to know whether drugs are safe, the nurse explains that all medications in the United States undergo rigorous scientific testing controlled by what organization? A) Food and Drug Administration (FDA)

12 Document shared on https://www.docsity.com/en/test-bank-for-karch-s-focus-on-nursing-pharmacology-9th-edition-by-rebecca-tucker/10381517/

B) Drug Enforcement Agency (DEA) C) Centers for Disease Control and Prevention (CDC) D) Joint Commission on Accreditation of Healthcare Organizations (JCAHO)

Ans: A

Feedback: The FDA is responsible for controlling and regulating the development and sale of drugs in the United States, allowing new drugs to enter the market only after being subjected to rigorous scientific testing. The DEA regulates and controls the use of controlled substances. The CDC monitors and responds to infectious diseases. The JCAHO is an accrediting body that inspects acute care facilities to ensure minimum standards are met.

Format: Multiple Choice Chapter: 1 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 12, Drug Evaluation 16. The nurse is assisting with a phase I drug study. What potential participant would be most appropriate? A) a 22-year-old male with an unremarkable health history B) a 24-year-old female who takes oral contraceptives C) a 49-year-old female who has completed menopause D) a 17-year-old male who is in good health

Ans: A

Feedback: Phase I drug trials usually involve healthy male volunteers because chemicals may exert an unknown and harmful effect on ova in women, which could

13 Document shared on https://www.docsity.com/en/test-bank-for-karch-s-focus-on-nursing-pharmacology-9th-edition-by-rebecca-tucker/10381517/

result in fetal damage when the woman becomes pregnant. Drugs are tested on both men and women, but women must be fully informed of risks and sign a consent stating they understand the potential for birth defects. A 17-year-old would normally be too young to participate.

Format: Multiple Choice Chapter: 1 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 2 Page and Header: 11, Drug Evaluation 17. The client tells the nurse about a new drug being tested to treat the disease they are diagnosed with, and asks the nurse whether the doctor can prescribe a medication still in the preclinical phase of testing. What is the nurse’s best response? A) “The doctor would have to complete a great deal of paperwork to get approval to prescribe that drug.” B) “Sometimes pharmaceutical companies are looking for volunteers to test a new drug and the doctor could give them your name.” C) “Drugs in the preclinical phase of testing are only tested on animals and so would not be available to you.” D) “Drugs in the preclinical phase of testing are given only to healthy young men and so would not be available to you.”

Ans: C

Feedback: During the preclinical phase of testing, drugs are tested on animals and are not available to clients. In phase I, the drug is tested on volunteers who are usually healthy young men. It is only in phase III studies that the drug is made available to prescribers who agree to closely monitor clients getting the medication.

14 Document shared on https://www.docsity.com/en/test-bank-for-karch-s-focus-on-nursing-pharmacology-9th-edition-by-rebecca-tucker/10381517/

Format: Multiple Selection Chapter: 1 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Communication and Documentation Objective: 2 Page and Header: 14, Drug Evaluation 18. The nurse is caring for a client who had a severe, acute, previously unseen adverse effect of a drug in phase III testing. The client asks, “After all the testing done on this drug, didn’t they know this adverse effect could occur?” What are appropriate responses by the nurse? Select all that apply. A) “Pharmaceutical companies sometimes underreport problems to make more money.” B) “Your response to this medication will be reviewed very closely to address possible adverse effects.” C) “Adverse effects are studied to determine whether the disease or the drug was the cause.” D) “The pharmaceutical company weighs the benefits of the drug with the severity of adverse effects.” E) After a drug reaches phase III testing, it is considered an accepted drug and will not be recalled.”

Ans: B, C

Feedback: Researchers observe clients very closely, monitoring them for any adverse effects. Often, participants are asked to keep journals and record any symptoms they experience. Researchers then evaluate the reported effects to determine whether they are caused by the disease or by the drug. It would be both unprofessional and inaccurate to imply that pharmaceutical companies put profit ahead of client concern because lawsuits would remove any potential profit if a drug proves harmful. The FDA is responsible for weighing risk versus benefit in deciding whether to allow the drug to

15 Document shared on https://www.docsity.com/en/test-bank-for-karch-s-focus-on-nursing-pharmacology-9th-edition-by-rebecca-tucker/10381517/

move to the next phase of testing. Drugs found to have serious adverse effects can be removed from the market at any time.

Format: Multiple Choice Chapter: 1 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Easy Integrated Process: Communication and Documentation Objective: 3 Page and Header: 19, Legal Regulation of Drugs 19. The telephone triage nurse receives a call from a client asking for a prescription for an opioid (narcotic) to manage the surgical pain. The nurse explains that opioid prescriptions must be written and cannot be called into the pharmacy. The client says, “Why are opioids 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 opioids are controlled by the FDA and the DEA.”

Ans: D

Feedback: Controlled substances are controlled by the FDA and the DEA: the DEA enforces control, while the FDA determines abuse potential. Regulations related to controlled substances have remained strict and specific and have not been significantly impacted by substance abusers. The CDC is not involved in control of opioids and other controlled substances.

16 Document shared on https://www.docsity.com/en/test-bank-for-karch-s-focus-on-nursing-pharmacology-9th-edition-by-rebecca-tucker/10381517/

Format: Multiple Choice Chapter: 1 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Easy Integrated Process: Teaching/Learning Objective: 3 Page and Header: 19, Legal Regulation of Drugs, Box 1.2 20. 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 client safety.” D) “Schedule I medications are found in antitussives and antidiarrheals sold over the counter.”

Ans: A

Feedback: Schedule I medications have no medical use and are never prescribed. Schedule II have high abuse potential with severe dependence liability. Schedule III have less abuse potential than schedule II drugs and moderate dependence liability. Schedule IV have less abuse potential than schedule III and limited dependence liability. Schedule V medications have the lowest risk for abuse and are found mostly in antitussives and antidiarrheals, but they are not sold over the counter.

Format: Multiple Choice Chapter: 1 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate

17 Document shared on https://www.docsity.com/en/test-bank-for-karch-s-focus-on-nursing-pharmacology-9th-edition-by-rebecca-tucker/10381517/

Integrated Process: Teaching/Learning Objective: 2 Page and Header: 18, Legal Regulation of Drug, Box 1.1 21. The nurse, working on the maternity unit, receives a call from a pregnant client asking how they can know whether a medication is safe to take while pregnant. What is the nurse’s best response? A) “You can take any drug indicated as a category A.” B) “No medications should be taken during pregnancy.” C) “Never take medication until you receive approval from your healthcare provider.” D) “Most medications are safe but you need to weigh benefit against risk.”

Ans: C

Feedback: The best response to a pregnant client asking about medication usage is to talk with their obstetric practitioner because the best advice will come from someone who knows their health and pregnancy history. While category A drugs have no known risk, they may be contraindicated by the client’s health condition or pregnancy issues, and many pregnant clients would not know what it means to be a category A drug. Medications can be helpful during pregnancy if taken safely and appropriately. Although risk benefit needs to be weighed, it should occur with advice from the obstetric practitioner.

Format: Multiple Choice Chapter: 1 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Easy Integrated Process: Teaching/Learning Objective: 3 Page and Header: 20, Legal Regulation of Drugs, Box 1.2 22. A client asks the nurse, “What is a Drug Enforcement Agency (DEA) number?” What is the nurse’s best response?

18 Document shared on https://www.docsity.com/en/test-bank-for-karch-s-focus-on-nursing-pharmacology-9th-edition-by-rebecca-tucker/10381517/

A) “DEA numbers are given to primary care providers (PCPs) and pharmacists when they register with the DEA to prescribe and dispense controlled substances.” B) “Providers must have a DEA number in order to prescribe any type of medication for clients.” C) “DEA numbers are case numbers given when someone breaks the law involving a controlled substance.” D) “DEA numbers the standardized codes for each drug that is on the market in the United States.”

Ans: A

Feedback: All pharmacists and providers must register with the DEA. They are given numbers that are required before they can dispense or prescribe controlled substances. DEA numbers are only needed when prescribing controlled substances. A DEA number is neither a case number nor a drug code.

Format: Multiple Choice Chapter: 1 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 20, Legal Regulation of Drugs 23. The nurse is preparing to move to another state. The nurse should complete which action? A) Become familiar with local policies and procedures for controlled substance administration. B) Obtain local providers’ Drug Enforcement Agency (DEA) number for prescribing controlled substances. C) Become familiar with pregnancy drug categorization system used in the new state. D) Learn about the particular OTC drugs that are for sale in the new state.

19 Document shared on https://www.docsity.com/en/test-bank-for-karch-s-focus-on-nursing-pharmacology-9th-edition-by-rebecca-tucker/10381517/

Ans: A Feedback: The nurse needs to learn local policies and procedures for controlled substance administration because they can vary with some local governments more rigorous than others. Nurses do not memorize a provider’s DEA numbers. The DEA is a federal agency that monitors controlled substances in all states. Pregnancy drug categories are standardized nationwide, and there is minimal variation on the availability of OTC drugs.

Format: Multiple Choice Chapter: 1 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 4 Page and Header: 21, Legal Regulation of Drugs 24. The client looks at the prescription provided by the doctor and asks the nurse about the notation “DAW.” What implication of this notation should the nurse explain? A) The prescription will be filled once the pharmacy is informed of the prescriber’s DEA number. B) The pharmacy where the client fills the prescription will not substitute a generic drug. C) The drug falls under the purview of the DEA’s Drug Action Watch program. D) The drug is associated with a high risk of adverse effects.

Ans: B

Feedback: DAW stands for “dispense as written” and means that the doctor does not want a generic substituted for the prescribed medication. This is unrelated to the prescriber’s DEA number, and there is no “Drug Action Watch Program.” The drug is not necessarily associated with a high risk of adverse effects. Format: Multiple Choice

20 Document shared on https://www.docsity.com/en/test-bank-for-karch-s-focus-on-nursing-pharmacology-9th-edition-by-rebecca-tucker/10381517/

Chapter: 1 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Easy Integrated Process: Teaching/Learning Objective: 4 Page and Header: 14, Drug Evaluation 25. The nurse is preparing to administer the drug papaverine (Pavabid). What does the nurse identify the name Pavabid as? A) the generic name B) the chemical name C) the brand name D) the chemical and generic name

Ans: C

Feedback: Several clues indicate the brand name including capitalization of the first letter in the name and in parentheses. Generic names are not capitalized; chemical names are descriptions of the chemistry of the medication resulting in complicated names.

Format: Multiple Choice Chapter: 1 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Teaching/Learning Objective: 4 Page and Header: 20, Legal Regulation of Drugs 26. The client is prescribed a medication that was just approved by the FDA. The client tells the nurse, “This medication is too expensive. Could the doctor order a generic form of this medication?” What is the nurse’s best response?

21 Document shared on https://www.docsity.com/en/test-bank-for-karch-s-focus-on-nursing-pharmacology-9th-edition-by-rebecca-tucker/10381517/

A) “New medications are patented by the manufacturers. A generic is not available.” 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.”

Ans: A

Feedback: 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.

Format: Multiple Selection Chapter: 1 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Easy Integrated Process: Teaching/Learning Objective: 4 Page and Header: 22, Legal Regulation of Drugs; Orphan Drugs 27. The nurse learns that a drug needed by the client is classified as an orphan drug. The nurse should recognize what possible characteristics of this drug? Select all that apply. A) The drug is rarely prescribed. B) The drug has dangerous adverse effects. C) The drug treats a rare disease. D) The patent on the medication is still effective. E) It is produced by a company that only manufactures drugs.

22 Document shared on https://www.docsity.com/en/test-bank-for-karch-s-focus-on-nursing-pharmacology-9th-edition-by-rebecca-tucker/10381517/

Ans: A, B, C

Feedback: Drugs are classified as orphan drugs when they are not financially viable for a drug company to produce either because of risk for lawsuits about adverse effects or because the drug is not prescribed, which is often seen in rare diagnoses. Generic drugs are not produced until the patent expires, but this has no impact on classifying a particular drug as an orphan drug. Generic drugs are often produced by companies that only manufacture drugs without conducting research, but this has no bearing on the classification of orphan drugs.

Format: Multiple Choice Chapter: 1 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 5 Page and Header: 23, Legal Regulation of Drugs 28. While collecting a medication history, the client admits to doubling the recommended dosage of acetaminophen, saying “It’s harmless or they would require a prescription.” What is the nurse’s best response? A) “OTC drugs are serious medications and carry serious risks if not taken as directed.” B) “Taking medications like that is careless and you could cause yourself serious harm if you keep doing it.” C) “Sometimes you need to take more than the package directs to treat the symptoms. It’s important not to do this frequently.” D) “Did you notify your doctor of the increased dosage you were taking?”

Ans: A

Feedback: OTC drugs are no less a medication than prescription drugs and carry the same types of risks for overdosage and toxicity if directions are not followed. Although

23 Document shared on https://www.docsity.com/en/test-bank-for-karch-s-focus-on-nursing-pharmacology-9th-edition-by-rebecca-tucker/10381517/

increasing the dosage is careless and dangerous, it is important to use the information as a teaching opportunity rather than scolding the client. Agreeing with the clients or asking them if they talked to the doctor misses the teaching opportunity, which could be harmful for the client.

Format: Multiple Selection Chapter: 1 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Teaching/Learning Objective: 5 Page and Header: 23, Legal Regulation of Drugs 29. The client asks the nurse, “Is it safe to take over-the-counter (OTC) medications with prescription medications?” What are appropriate responses by the nurse? Select all that apply. A) “OTC medications can interact with prescription medications.” B) “It is important to tell your doctor all medications you take, including OTC.” C) “OTC medications could mask or hide signs and symptoms of a disease.” D) “You should avoid taking any OTC medication when taking prescription drugs.” E) “Taking OTC medications can make your prescription medication more effective.”

Ans: A, B, C Feedback: OTC medications can interact with prescription medications or other OTC so it is always important to consult your pharmacist and provider for advice. To provide the most accurate instruction, the healthcare provider must know all medications taken including dietary supplements, OTC, and prescription. OTC medications could mask or hide symptoms of a disease so it is always important to consult a health care provider if symptoms persist. OTC medications are not prohibited when taking prescription drugs as long as no drug interaction occurs. How an OTC will impact a prescription medication varies depending on the medications involved, so it is incorrect to say it will make the prescription drug more effective.

24 Document shared on https://www.docsity.com/en/test-bank-for-karch-s-focus-on-nursing-pharmacology-9th-edition-by-rebecca-tucker/10381517/

Format: Multiple Selection Chapter: 1 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 25, Sources of Drug Information 30. Before administering a prescription medication, the nurse should confirm what information on the drug label? Select all that apply. A) brand name B) generic name C) drug dosage D) expiration date E) adverse effects F) therapeutic effects

Ans: A, B, C, D Feedback: Prescription drug labels will contain the brand name, generic name, drug dosage, and expiration date. Adverse effects and therapeutic uses will not be listed on drug labels.

Format: Multiple Choice Chapter: 1 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Remember Difficulty: Easy Integrated Process: Nursing Process Objective: 5 Page and Header: 25, Sources of Drug Information

25 Document shared on https://www.docsity.com/en/test-bank-for-karch-s-focus-on-nursing-pharmacology-9th-edition-by-rebecca-tucker/10381517/

31. The nurse explains that what drug resource book is compiled from package inserts? A) Nurses Drug Guide B) Physicians’ Desk Reference (PDR) C) Drug Facts and Comparisons D) AMA Drug Evaluations

Ans: B

Feedback: The PDR is a compilation of information found on package inserts. The Nurses Drug Guide uses more easily understood language and incorporates nursing considerations and client teaching points. Drug Facts and Comparisons includes cost comparison, often not found in other drug resource guides. The AMA Drug Evaluations is far less biased than the PDR and includes drugs still in the research stage of development.

Format: Multiple Choice Chapter: 1 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 5 Page and Header: 27, Sources of Drug Information 32. A client has been prescribed a new medication but is skeptical to begin taking it after reading about potential risks in an online discussion forum. What is the nurse’s best response? A) “It’s excellent that you’re investigating your medications. Can I recommend some useful websites for you?” B) “Just remember that there is a lot of highly inaccurate information on the internet. A lot of the time it’s best to just avoid it.” C) “How did you find that particular discussion forum?”

26 Document shared on https://www.docsity.com/en/test-bank-for-karch-s-focus-on-nursing-pharmacology-9th-edition-by-rebecca-tucker/10381517/

D) “Knowledge is power.” “The more information you can get about something as important as your health, the better.”

Ans: A

Feedback: The nurse can promote a therapeutic dialogue by commending the client’s efforts and hopefully directing the client to valid and reliable information sources. The nurse must avoid reprimanding the client. The method by which the client found the discussion forum is not important. The nurse should not suggest that any, and all, information is beneficial or equally valid.

Format: Multiple Choice Chapter: 1 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 5 Page and Header: 27, Sources of Drug Information 33. Which journal should the nurse use to best support effective nursing practice? A) American Journal of Nursing B) Medical Letter C) Journal of American Medical Association D) New England Journal of Medicine

Ans: A

Feedback: The American Journal of Nursing offers information on new drugs, drug errors, and nursing implications. While the other options may provide medication-related information, none are as specific to nursing as is the American Journal of Nursing and it’s identified focus on nursing practice.

27 Document shared on https://www.docsity.com/en/test-bank-for-karch-s-focus-on-nursing-pharmacology-9th-edition-by-rebecca-tucker/10381517/

Test Generator Questions, Chapter 2, Drugs and the Body Format: Multiple Choice Chapter: 2 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 22, Pharmacokinetics 1. The nurse is caring for a diverse group of clients. In which client should the nurse 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 32-year-old woman with urosepsis

Ans: C

Feedback: The liver is the most important site of drug metabolism. If the liver is not functioning effectively, as in clients with cirrhosis, drugs will not metabolize normally so that toxic levels could develop unless dosage is reduced. A client with cervical cancer or kidney stones would not be expected to have altered ability to metabolize drugs so long as no liver damage existed. Infections such as urosepsis would not have a direct impact on metabolism.

Format: Fill-in-the-Blank Chapter: 2 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Nursing Process

28 Document shared on https://www.docsity.com/en/test-bank-for-karch-s-focus-on-nursing-pharmacology-9th-edition-by-rebecca-tucker/10381517/

Objective: 3 Page and Header: 22, Pharmacokinetics; 27, Box 2.2 2. A client presents to the emergency department with a drug level of 50 units/mL. The half-life of this drug is 1 hour. With this drug, concentrations above 25 units/mL are considered toxic, and no more drug is given. How long will it take for the blood level to reach the nontoxic range? Provide your answer measured in minutes.

Ans: 60 minutes

Feedback: Half-life is the time required for the serum concentration of a drug to decrease by 50%. After 1 hour, the serum concentration would be 25 units/mL (50/2) if the body can properly metabolize and excrete the drug.

Format: Multiple Choice Chapter: 2 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Nursing Process Objective: 4 Page and Header: 28, Factors Influencing Drug Effects; 28, Box 2.3 3. A client has recently moved from Vermont to South Florida. The client presents to the clinic reporting “dizzy spells” and weakness. The client tells the nurse that they have been on the same antihypertensive drug for 6 years, with stable blood pressures and no adverse effects. The clinic nurse knows that one possible reason for the change in the effectiveness of the drug could be what? A) the impact of psychosocial stress associated with moving B) the accumulative effect of the drug if it has been taken for many years C) the impact of the warmer environment on the client’s physical status D) problems with client adherence with the drug regimen while on vacation Ans: C

29 Document shared on https://www.docsity.com/en/test-bank-for-karch-s-focus-on-nursing-pharmacology-9th-edition-by-rebecca-tucker/10381517/

Feedback: Antihypertensive drugs work to decrease the blood pressure. When a client goes to a climate that is much warmer than usual, blood vessels dilate and the blood pressure falls. If a client is taking an antihypertensive drug and moves to a warmer climate, there is a chance that the client’s blood pressure will drop too low, resulting in dizziness and feelings of weakness. Even mild dehydration could exacerbate these effects. Most antihypertensives are metabolized and excreted and do not accumulate in the body. Clients must adhere to their drug regimen on vacation, but this client is not on vacation. Psychosocial factors must be considered, but the client is describing a physiological response.

Format: Multiple Choice Chapter: 2 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 5 Page and Header: 28, Factors Influencing Drug Effects; 32, Box 2.5 4. The nurse is providing medication teaching for a client. The nurse has asked the client to provide a complete list of medications taken to health care providers. Ensuring this list is complete will have what potential benefit for the client? A) reducing the client’s spending on medications B) protecting the client from possible allergic reactions to medications C) reducing the client’s likelihood of drug–drug interactions D) maintaining a therapeutic serum concentration of the new drug

Ans: C

Feedback: It is important that all health care providers have a complete list of the client’s medications to avoid drug–drug interactions caused by one provider ordering a medication, unaware of another medication the client is taking that could interact with the new prescription. Informing the provider of all medications taken will not reduce

30 Document shared on https://www.docsity.com/en/test-bank-for-karch-s-focus-on-nursing-pharmacology-9th-edition-by-rebecca-tucker/10381517/

costs of medications, which is best accomplished by requesting generic medications. Allergies should be disclosed to all health care providers as well, but this is not why it is important to provide a complete list of medications taken. Ensuring that the client’s drug regimen is fully disclosed will not have direct effect on serum concentrations of the new drug.

Format: Multiple Choice Chapter: 2 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 1 Page and Header: 20, Pharmacodynamics 5. A client has been prescribed a medication that is known to be a drug agonist. This drug will have what effect? A) It will react with a receptor site on a cell preventing a reaction with another chemical on a different receptor site. B) The drug will interfere with the enzyme systems that act as catalyst for different chemical reactions. C) The drug will interact directly with receptor sites to cause the same activity that a natural chemical would cause at that site. D) It will react with receptor sites to block normal stimulation, producing no effect.

Ans: C

Feedback: Agonists are drugs that produce effects similar to those produced by naturally occurring neurotransmitters, hormones, or other substances found in the body. Noncompetitive antagonists are drugs that react with some receptor sites preventing the reaction of another chemical with a different receptor site. Drug–enzyme interactions interfere with the enzyme systems that stimulate various chemical reactions.

31 Document shared on https://www.docsity.com/en/test-bank-for-karch-s-focus-on-nursing-pharmacology-9th-edition-by-rebecca-tucker/10381517/

Format: Multiple Choice Chapter: 2 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 22, Pharmacokinetics 6. A nurse is caring for a client who has been receiving a drug by the intramuscular route at a dose of 0.25 mg. After discharge, the client will be prescribed the same medication orally at a dose of 2.5 mg. What phenomenon should the nurse describe when explaining the reason for the increased dosage for the oral dose? A) passive diffusion B) active transport C) glomerular filtration D) first-pass effect

Ans: D

Feedback: 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. After reaching the liver, enzymes break the drug into metabolites, which may become active or may be deactivated and readily excreted from the body. A large percentage of the oral dose is usually destroyed and never reaches tissues. Oral dosages account for the phenomenon to ensure an appropriate amount of the drug in the body to produce a therapeutic action. Passive diffusion is the major process through which drugs are absorbed into the body. Active transport is a process that uses energy to actively move a molecule across a cell membrane and is often involved in drug excretion in the kidney. Glomerular filtration is the passage of water and water-soluble components from the plasma into the renal tubule.

32 Document shared on https://www.docsity.com/en/test-bank-for-karch-s-focus-on-nursing-pharmacology-9th-edition-by-rebecca-tucker/10381517/

Format: Multiple Choice Chapter: 2 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 4 Page and Header: 28, Factors Influencing Drug Effects 7. A client’s unexpected response to a new medication has been attributed to characteristics of the client’s genetic makeup. What area of study best explains this client’s medication response? A) pharmacotherapeutics B) pharmacodynamics C) pharmacoeconomics D) pharmacogenomics

Ans: D

Feedback: Pharmacogenomics is the area of study that includes mapping of the human genome. In the future, medical care and drug regimens may be personally designed based on a client’s unique genetic makeup. Pharmacotherapeutics is the branch of pharmacology that deals with the uses of drugs to treat, prevent, and diagnose disease. Pharmacodynamics involves how a drug affects the body. Pharmacoeconomics includes the costs involved in drug therapy.

33 Document shared on https://www.docsity.com/en/test-bank-for-karch-s-focus-on-nursing-pharmacology-9th-edition-by-rebecca-tucker/10381517/

Page and Header: 22, Pharmacokinetics 8. The serum lithium levels of a client diagnosed with bipolar disorder have risen to the minimum level required to have a therapeutic effect. What term is used to describe this situation? A) critical concentration B) dynamic equilibrium C) a stable half-life D) benefits of active transport

Ans: A

Feedback: A critical concentration of a drug must be present before a reaction occurs within the cells to bring about the desired therapeutic effect. A dynamic equilibrium is obtained from absorption of a drug from the site of drug entry, distribution to the active site, metabolism in the liver, and excretion from the body to have a critical concentration. Active transport is the process that uses energy to actively move a molecule across a cell membrane and is often involved in drug excretion in the kidney. The half-life of a drug affects the achievement and maintenance of a critical concentration, but this drug level is not the half-life itself.

34 Document shared on https://www.docsity.com/en/test-bank-for-karch-s-focus-on-nursing-pharmacology-9th-edition-by-rebecca-tucker/10381517/

C) Assess the client’s knowledge of the medications. D) Identify the client by checking the armband and asking the client’s name.

Ans: B

Feedback: A nurse should first consult a drug guide for interactions when two or more drugs are being given at the same time. After this review, the medication can be administered. The nurse will perform hand hygiene, check for client allergies, and ensure that the right client receives the medication by using two identifiers. It is important to assess clients’ knowledge of their medications, but ensuring compatibility is a priority.

Format: Multiple Choice Chapter: 2 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 28, Factors Influencing Drug Effects; 28, Box 2.3 10. The nurse is preparing to administer an intramuscular dose of meperidine to a client in pain. The nurse should identify what factor that will affect the absorption of the drug by this route? A) perfusion of blood to the subcutaneous tissue B) integrity of the client mucous membranes C) environmental temperature D) the amount of adipose tissue that the client has

Ans: C

Feedback: 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. Blood flow to the subcutaneous tissues interferes with subcutaneous

35 Document shared on https://www.docsity.com/en/test-bank-for-karch-s-focus-on-nursing-pharmacology-9th-edition-by-rebecca-tucker/10381517/

injection. Intramuscular injections enter muscle, so the amount of adipose tissue that the client has will not have a direct effect on absorption. The condition of mucous membranes can interfere with sublingual (under the tongue) and buccal (in the cheek) administration of drugs.

Format: Multiple Choice Chapter: 2 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 1 Page and Header: 20, Pharmacodynamics 11. The client 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

Ans: A

Feedback: Many drugs are thought to act at specific areas on cell membranes called receptor sites. After the receptor site is activated, this in turn activates the enzyme systems to produce certain effects, such as increased or decreased cellular activity, changes in cell membrane permeability, or alterations in cellular metabolism. Receptor sites are generally located on the outside of cells and allow the drug to bypass the cell membrane. The Golgi body and endoplasmic reticulum are not involved in this process.

Format: Multiple Selection Chapter: 2

36 Document shared on https://www.docsity.com/en/test-bank-for-karch-s-focus-on-nursing-pharmacology-9th-edition-by-rebecca-tucker/10381517/

Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 22, Pharmacokinetics 12. What physiologic processes contribute to the achievement of dynamic equilibrium when a nurse administers a drug? Select all that apply. A) distribution to the site where the drug is active B) biotransformation C) absorption from site where the drug enters the body D) excretion from the body E) interaction with other drugs

Ans: A, B, C, D Feedback: 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, and excretion from the body. Interaction with other drugs is not part of the dynamic equilibrium.

Format: Multiple Choice Chapter: 2 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 22, Pharmacokinetics 13. A nurse is administering digoxin to a client. To administer medications so that the drug is as effective as possible, the nurse should prioritize what factor?

37 Document shared on https://www.docsity.com/en/test-bank-for-karch-s-focus-on-nursing-pharmacology-9th-edition-by-rebecca-tucker/10381517/

A) the client’s preferences B) the process of pharmacokinetics C) educating the client about potential adverse effects D) the client’s culture and ethnicity

Ans: B

Feedback: When administering a drug, the nurse needs to consider the phases of pharmacokinetics so that the drug regimen can be made as effective as possible. The client should be educating about adverse effects, but this action does not directly influence effectiveness. Similarly, the nurse must always consider clients’ preferences, culture, and ethnicity, but these variables are less significant than the broader process of pharmacokinetics.

Format: Multiple Choice Chapter: 2 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 22, Pharmacokinetics 14. 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 client is taking D) how long the client has to take the drug

Ans: A

Feedback: These processes are key elements in determining the amount of drug (dose) and the frequency of dose repetition (scheduling) required to achieve the critical

38 Document shared on https://www.docsity.com/en/test-bank-for-karch-s-focus-on-nursing-pharmacology-9th-edition-by-rebecca-tucker/10381517/

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 client is taking or how long the client has to take the drug.

Format: Multiple Choice Chapter: 2 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Remember Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 22, Pharmacokinetics 15. The nurse is assessing factors that may affect the absorption of a drug that the nurse will soon administer. What factor should the nurse prioritize? A) the client’s blood urea nitrogen and creatinine levels B) the route of administration that has been prescribed C) the client’s liver enzyme levels D) the date on which the client began taking the medication

Ans: B

Feedback: 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 while liver function impacts metabolism. The length of time the client has been taking the drug has no appreciable effect on absorption.

Format: Multiple Choice Chapter: 2 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand

39 Document shared on https://www.docsity.com/en/test-bank-for-karch-s-focus-on-nursing-pharmacology-9th-edition-by-rebecca-tucker/10381517/

Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 22, Pharmacokinetics 16. The nurse has administered a drug that is known to be lipid soluble. This drug’s solubility will primarily affect what aspect of pharmacokinetics? A) absorption of the drug B) metabolism of the drug C) excretion of the drug D) distribution of the drug

Ans: D

Feedback: 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.

Format: Multiple Choice Chapter: 2 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 3 Page and Header: 22, Pharmacokinetics; 27, Box 2.2 17. A nurse has identified the half-life of a drug that will be administered to a client for the first time. The nursing drug guide states that the drug’s half-life is 90 minutes. The nurse should identify what implication of this fact? A) Ninety minutes after drug levels peak, there will be 50% of the peak level. B) In 3 hours, there will be no detectable levels of the drug present in the client’s body. C) Drug levels will rise steadily after administration, reaching 50% of maximum concentration after 90 minutes.

40 Document shared on https://www.docsity.com/en/test-bank-for-karch-s-focus-on-nursing-pharmacology-9th-edition-by-rebecca-tucker/10381517/

D) Peak drug levels will be achieved 90 minutes after the drug is administered.

Ans: A

Feedback: 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. In this case, 50% of peak levels will be achieved 90 minutes after the peak. Two half-life cycles of 90 minutes each (3 hours) would result in a concentration of 25% of the peak (50% of 50%). Format: Fill-in-the-Blank Chapter: 2 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 22, Pharmacokinetics; 27, Box 2.2 18. The client is taking a 2-mg dose of ropinirole XR. The drug has a half-life of 12 hours. In how many hours will 0.25 mg of this drug remains in the client’s system?

Ans: 36 hours

Feedback: 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.

Format: Fill-in-the-Blank Chapter: 2 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult

41 Document shared on https://www.docsity.com/en/test-bank-for-karch-s-focus-on-nursing-pharmacology-9th-edition-by-rebecca-tucker/10381517/

Integrated Process: Nursing Process Objective: 3 Page and Header: 22, Pharmacokinetics; 27, Box 2.2 19. The client has been diagnosed with multiple sclerosis and is taking the drug interferon beta-1a. The client takes this drug by subcutaneous injection three times a week. The dosage is 44 mcg per injection. If the client takes an injection on Monday, how many micrograms of the drug would still be in the client’s system when they take the next injection on Wednesday, assuming the half-life of the drug is 24 hours?

Ans: 11 mcg

Feedback: The half-life of a drug is the time it takes for the amount of drug in the body to decrease to one-half the peak level it previously achieved. On Tuesday, there would be 22 mcg remaining in the body. On Wednesday, 11 mcg would remain. At 12 hours before taking the next dose on Wednesday, there would be 16.5 mcg remaining. If the injection were not taken on Wednesday, 12 hours after the dose was due, there would be 5.5 mcg remaining.

Format: Multiple Choice Chapter: 2 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Nursing Process Objective: 3 Page and Header: 22, Pharmacokinetics; 27, Box 2.2 20. The client 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, approximately how much amoxicillin would be in the child’s body at the time of the next administration of the drug? A) 63 mg B) 47 mg C) 31 mg

42 Document shared on https://www.docsity.com/en/test-bank-for-karch-s-focus-on-nursing-pharmacology-9th-edition-by-rebecca-tucker/10381517/

D) 16 mg

Ans: C Feedback: The half-life of a drug is the time it takes for the amount of drug in the body to decrease to one-half the peak level it previously achieved. There would be 62.5 mg at 3 hours after the original dose of amoxicillin. There would be 46.875 mg present 4½ hours after the original dose. There would be 31.25 mg at 6 hours after the original dose. There would be 15.625 mg at 7½ hours after the original dose.

Format: Fill-in-the-Blank Chapter: 2 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 22, Pharmacokinetics; 27, Box 2.2 21. A drug with a half-life of 4 hours is administered at a dosage of 100 mg. How many milligrams of the drug will be in the client’s system 8 hours after administration?

Ans: 25 mg

Feedback: The half-life of a drug is the time it takes for the amount of drug in the body to decrease to one-half the peak level it previously achieved. Two half-life cycles would yield a serum concentration of 25% of the peak (50% of 50%) or 25 mg in this case.

Format: Multiple Choice Chapter: 2 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate

43 Document shared on https://www.docsity.com/en/test-bank-for-karch-s-focus-on-nursing-pharmacology-9th-edition-by-rebecca-tucker/10381517/

Integrated Process: Nursing Process Objective: 3 Page and Header: 22, Pharmacokinetics; 27, Box 2.2 22. 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 hour 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

Ans: C

Feedback: 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. At a dose of 500 mg, the drug level would be 250 mg in 1 hour, 125 mg in 2 hours, 62.5 mg in 3 hours, and 31.25 mg in 4 hours so the correct answer is 3 hours.

Format: Multiple Choice Chapter: 2 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 4 Page and Header: 22, Pharmacokinetics 23. The nurse is caring for a client diagnosed with a brain infection of bacterial etiology. When administering medications to this client, the nurse should prioritize what variable related to the client’s diagnosis? A) The client will require lipid-soluble antibiotics. B) The client’s blood–brain barrier will not allow medications to affect brain tissue. C) Antibiotics will have to be injected directly into brain tissue.

44 Document shared on https://www.docsity.com/en/test-bank-for-karch-s-focus-on-nursing-pharmacology-9th-edition-by-rebecca-tucker/10381517/

D) Active infection may destroy the integrity of the blood–brain barrier.

Ans: A

Feedback: Effective antibiotic treatment can occur only when the infection is severe enough to alter the blood–brain barrier and allow antibiotics to cross. Lipid-soluble, not water-soluble, medications cross the blood–brain barrier more easily, and most antibiotics are not lipid soluble, so they are not the exception. No matter where the infection originates, drugs must cross the blood–brain barrier to treat central nervous system infections. Infection will not destroy the blood–brain barrier, which blocks drugs selectively.

Format: Multiple Choice Chapter: 2 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 4 Page and Header: 22, Pharmacokinetics 24. The client with a history of ischemic heart disease is prescribed aspirin 81 mg daily. The nurse should explain that less than 81 mg actually reaches target tissue due to which action? A) slow distribution B) first-pass effect C) reduced absorption D) adverse effects

Ans: B Feedback: Drugs that are taken orally are usually absorbed from the small intestine directly into the portal venous system. These absorbed molecules are then delivered into the liver, which immediately breaks the drug into metabolites, some of which are active

45 Document shared on https://www.docsity.com/en/test-bank-for-karch-s-focus-on-nursing-pharmacology-9th-edition-by-rebecca-tucker/10381517/

and cause effects in the body and some of which are deactivated and can be readily excreted from the body. A large percentage of the oral dose is destroyed at this point and never reaches the tissues. This process is caused by the first-pass effect, not by slow distribution, reduced absorption, or adverse drug effects.

Format: Multiple Choice Chapter: 2 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 5 Page and Header: 31, Nursing Care Guide for R.D 25. The nurse is reviewing the results of the client’s laboratory tests. What factor should the nurse most consider when reviewing these results related to medication administration? A) the client’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 drug–laboratory test interaction D) a change in the body’s responses or actions related to the drug

Ans: C

Feedback: The body works through a series of chemical reactions. Because of this, administration of a particular drug may alter results of tests that are done on various chemical levels or reactions as part of a diagnostic study. This drug–laboratory test interaction is caused by the drug being given and not necessarily by a change in the body’s responses or actions. The client’s emotional response or timing of the last dose is not important in drug–laboratory interactions.

Format: Multiple Selection

46 Document shared on https://www.docsity.com/en/test-bank-for-karch-s-focus-on-nursing-pharmacology-9th-edition-by-rebecca-tucker/10381517/

Chapter: 2 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 5 Page and Header: 31, Nursing Care Guide for R.D. 26. A client has been diagnosed with gonorrhea and been prescribed oral tetracycline. What should the nurse include in health education about tetracycline? Select all that apply. A) Avoid excessive sodium intake for the duration of treatment. B) Do not take the drug with foods or other drugs that contain calcium. C) Do not take the drug at the same time as an iron supplements or high-iron foods. D) Avoid OTC medications that contain aspirin. E) Avoid salt substitutes and foods that are high in potassium.

Ans: B, C

Feedback: 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. There is no particular need to avoid sodium, potassium, or aspirin.

47 Document shared on https://www.docsity.com/en/test-bank-for-karch-s-focus-on-nursing-pharmacology-9th-edition-by-rebecca-tucker/10381517/

27. A nurse is caring for a client taking multiple drugs and is concerned about a possible drug–drug interaction. How should the nurse best avoid a drug–drug interaction? A) Consult a drug guide prior to drug administration. B) Perform a comprehensive health assessment prior to drug administration. C) Ensure that there is 90 minutes between administration of different drugs. D) Ask for input from a pharmacist or the prescriber.

Ans: A

Feedback: Whenever two or more drugs are being given together, first consult a drug guide for a listing of clinically significant drug–drug interactions. There may be a possibility of changing administration times, but the nurse cannot unilaterally make this decision. Health assessment prior to administration has no direct effect on the likelihood of a drug–drug interaction. It is prudent to collaborate with the prescriber and/or the pharmacist, but this does not negate the need to consult reputable published information.

Format: Multiple Selection Chapter: 2 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 4 Page and Header: 31, Nursing Care Guide for R.D. 28. The nurse should promote optimal drug effectiveness by performing what actions? 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 within the nursing scope of practice to modify adverse or intolerable effects. D) Minimize the number of medications administered to clients.

48 Document shared on https://www.docsity.com/en/test-bank-for-karch-s-focus-on-nursing-pharmacology-9th-edition-by-rebecca-tucker/10381517/

E) Examine factors known to influence specific drugs if they are to be effective.

Ans: A, B, C, E

Feedback: Incorporate basic history and physical assessment factors into any plan of care so that obvious problems can be identified and handled promptly. If a drug simply does not do what it is expected to do, further examine the factors that are known to influence drug effects. Frequently, the drug regimen can be modified to deal with that influence. Minimizing the number of medications administered is usually not an option because each drug is ordered for a reason of necessity for the client. Minimizing drugs reduce the risk of adverse effects and drug–drug interactions, but it does not enhance effectiveness of drugs.

Ans: A

49 Document shared on https://www.docsity.com/en/test-bank-for-karch-s-focus-on-nursing-pharmacology-9th-edition-by-rebecca-tucker/10381517/

Feedback: 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. Drug–drug interactions are always a risk, but this risk is not increased by impaired renal function. Renal function has no effect on absorption, and it does not increase tolerance.

Format: Multiple Choice Chapter: 2 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 5 Page and Header: 28, Factors Influencing Drug Effects 30. The client diagnosed with terminal cancer pain has been receiving morphine sulfate for several days. For the past few days, the medication is no longer effective in controlling the client’s pain, and a larger dose is needed to have the same effect. How should the nurse explain this phenomenon to the client? A) “This is likely a result of your developing tolerance to the medication.” B) “There is likely a build-up of morphine in your body that is unable to affect your pain receptors.” C) “I’ll collaborate with your provider to see if there might be other medications that are counteracting your morphine.” D) “You might be developing a mild addiction to morphine, but this is certainly treatable.”

Ans: A

Feedback: The body may develop a tolerance to some drugs over time. Tolerance may arise because of increased biotransformation of the drug, increased resistance to its effects, or other pharmacokinetic factors. When tolerance occurs, the amount of the drug

50 Document shared on https://www.docsity.com/en/test-bank-for-karch-s-focus-on-nursing-pharmacology-9th-edition-by-rebecca-tucker/10381517/

no longer causes the same reaction. Therefore, increasingly larger doses are needed to achieve a therapeutic effect. This is not synonymous with addiction, which is psychological dependence. The client’s need for higher doses does not suggest drug accumulation.

Format: Multiple Choice Chapter: 2 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Nursing Process Objective: 4 Page and Header: 28, Factors Influencing Drug Effects 31. The client expresses relief to the nurse after being prescribed a new medication, stating that they expect to experience great benefits. The nurse suspects this drug will be more effective than usual for this client because of what effect? A) cumulative effect B) first-pass effect C) placebo effect D) cross-tolerance effect

Ans: C

Feedback: A drug is more likely to be effective if the client thinks it will work than if the client believes it will not work. This is called the placebo effect. 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. First-pass effect addresses the reduction of available drug when taken orally due to metabolism in the liver before the drug reaches the bloodstream. Cross-tolerance is resistance to drugs within the same class.

51 Document shared on https://www.docsity.com/en/test-bank-for-karch-s-focus-on-nursing-pharmacology-9th-edition-by-rebecca-tucker/10381517/

Format: Multiple Selection Chapter: 2 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 22, Pharmacokinetics 32. The nurse administers an intravenous medication with a half-life of 24 hours. The nurse should recognize what factors in this client that 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

Ans: B, C, D Feedback: 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.

52 Document shared on https://www.docsity.com/en/test-bank-for-karch-s-focus-on-nursing-pharmacology-9th-edition-by-rebecca-tucker/10381517/

Page and Header: 28, Factors Influencing Drug Effects 33. What information should the nurse provide a client who has developed antibodies to a newly prescribed biological medication? A) “The antibodies will prevent you from becoming allergic to the drug.” B) “You are now allergic to the proteins in the drug itself.” C) “These antibodies will make the medication extremely effective.” D) “You may experience an allergic reaction to this medication if you receive it again.”

Ans: D

Feedback: People can develop allergies to drugs. After exposure to a drug’s proteins, a person can develop antibodies to that drug. The client is not allergic to the medication’s proteins currently, but with future exposure to the drug, that person may experience a full-blown allergic reaction. Biological medications may lose efficacy in clients who have developed antibodies to those medications. This is most common with biologic medications.

Test Generator Questions, Chapter 3, Toxic Effects of Drugs Format: Multiple Choice Chapter: 3 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 1 Page and Header: 36, Adverse Effects; 37, Box 3.1 1. A nurse is planning client teaching about a newly prescribed drug. What teaching point should the nurse provide to best improve adherence and safety? A) list of pharmacies where the drug can be obtained B) measures to alleviate any discomfort associated with adverse effects C) the benefits of the prescribed drug over alternatives from the same class D) statistics related to phase III testing for the prescribed drug

53 Document shared on https://www.docsity.com/en/test-bank-for-karch-s-focus-on-nursing-pharmacology-9th-edition-by-rebecca-tucker/10381517/

Ans: B

Feedback: If a client is aware of certain adverse effects and how to alleviate or decrease the discomfort, they are more likely to continue taking the medication. A list of pharmacies can be useful information but will not improve safety or compliance. Knowing the relative benefits of the drug over alternatives may enhance adherence but has no effect on safety. Most clients are not concerned with the statistics related to drug testing, and it would not improve adherence or safety even if the client was interested in the information.

Format: Multiple Choice Chapter: 3 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 38, Drug-Induced Tissue and Organ Damage 2. A client presents at the clinic reporting vaginal itching and a clear discharge. The client reports to the nurse that they have been taking an oral antibiotic for 10 days. What is the nurse’s best action? A) Assess for further signs of an adverse reaction to the antibiotic. B) Advocate for discontinuation of the drug due to the presence of toxic effects. C) Educate the client about the fact that an overdose may be damaging more than one body system. D) Educate the client about the likelihood of a superinfection caused by destruction of normal flora.

Ans: D

54 Document shared on https://www.docsity.com/en/test-bank-for-karch-s-focus-on-nursing-pharmacology-9th-edition-by-rebecca-tucker/10381517/

Feedback: Superinfections often occur with antibiotic use because the drug kills normal bacterial flora. This is not a result of toxic levels of the antibiotic, but rather an effect of the medication that has killed normal flora, which it is designed to do. Vaginal itching and a clear discharge are not considered adverse effects of an antibiotic. An overdose of a drug that damages more than one body systems is considered drug poisoning.

Format: Multiple Choice Chapter: 3 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 1 Page and Header: 36, Adverse Effects 3. A client experiencing seasonal allergies is taking an over-the-counter (OTC) antihistamine to relieve itchy, watery eyes, and a runny nose. When planning teaching for this client, the nurse would include what teaching point? A) Limit fluid intake to dry out mucous membranes. B) Avoid driving or operating machinery. C) There’s a possibility of insomnia. D) Grapefruit juice should be avoided during treatment.

Ans: B

Feedback: An adverse effect of antihistamines is drowsiness, so that injury to the client or others can occur if driving or operating machinery. An increase in fluids would be indicated to help keep nasal membranes moist. Drowsiness is more likely than insomnia. Grapefruit juice does not interfere with the metabolism of antihistamines.

Format: Multiple Choice Chapter: 3

55 Document shared on https://www.docsity.com/en/test-bank-for-karch-s-focus-on-nursing-pharmacology-9th-edition-by-rebecca-tucker/10381517/

Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Teaching/Learning Objective: 4 Page and Header: 40, Toxicity 4. A nurse is providing teaching to a group of clients who are beginning drug therapy for human immunodeficiency syndrome (HIV). What should the nurse teach the group? A) “Make sure not to take more than prescribed, because poisoning can cause damage to more than one body system.” B) “Damage to your kidneys can result when the drug is excreted from the system by what’s called the ‘first-pass effect’.” C) “A blood dyscrasia due to drug therapy can be serious. Call us if your skin looks yellowish or you experience itching.” D) “Most drugs are processed in the liver, and the first indication of damage is dark red bumps on your skin, which should be reported immediately.”

Ans: A

Feedback: Poisoning resulting from overdosage can lead to the potential for fatal reactions when more than one body system is affected. Liver, not kidney, injury can be caused by the first-pass effect and can cause the skin to have a yellow appearance. Most drugs are metabolized in the liver, but liver damage causes jaundice, manifested as a yellow tinge to the skin and sclera. Dark red papules appearing on limbs are characteristic of Stevens–Johnson syndrome, a potentially fatal erythema multiforme exudativum, which should be reported but is not due to liver damage.

Format: Multiple Choice Chapter: 3 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Difficult

56 Document shared on https://www.docsity.com/en/test-bank-for-karch-s-focus-on-nursing-pharmacology-9th-edition-by-rebecca-tucker/10381517/

Integrated Process: Nursing Process Objective: 3 Page and Header: 41, Electrolyte Imbalances 5. The nurse is caring for a client who has been taking potassium-sparing diuretic. What assessment finding would suggest an adverse reaction? A) urine output of 1,500 mL/24 hours B) blood pressure of 98/60 mm Hg C) heart rate of 47 beats/min D) calcium level of 10.6 mg/dL (2.5 mmol/L)

Ans: C

Feedback: Potassium-sparing diuretics carry a risk of hyperkalemia. The normal range of serum potassium for an adult is 3.5 to 5.0 mEq/L. A level higher than 5.0 mEq/L can indicate hyperkalemia, which can result in bradycardia. Normal urinary output is between 1,500 and 2,000 cc/d. Urinary output below 1,000/d would include oliguria and would indicate hyperkalemia. A decrease in blood pressure and pulse can indicate hypokalemia. Calcium levels would not normally be affected.

Format: Multiple Choice. Chapter: 3 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Difficult Integrated Process: Teaching/Learning Objective: 3 Page and Header: 42, Sensory Effects 6. An older adult who has been taking a macrolide antibiotic has developed auditory nerve damage. What instructions should the nurse provide for the family regarding home care? A) Keep the client in a prone position when in bed. B) Minimize the client’s sodium intake.

57 Document shared on https://www.docsity.com/en/test-bank-for-karch-s-focus-on-nursing-pharmacology-9th-edition-by-rebecca-tucker/10381517/

C) Provide protective measures to prevent falling or injury. D) Limit the client’s exposure to sunlight.

Ans: C

Feedback: Macrolide antibiotics can cause severe auditory nerve damage, which can cause dizziness, ringing in the ears (tinnitus), and loss of balance and hearing. The client would be at high risk for injury due to falls. Usually a person who is dizzy is unable to lie flat and needs to recline with the head elevated. Sodium and sunlight limitations are not components of this client’s health needs.

Format: Multiple Choice Chapter: 3 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 41, Alterations in Glucose Metabolism 7. The nurse is providing care for a client diagnosed with type 2 diabetes who is being treated with glipizide. The nurse recognizes it is important to monitor the client for which potential adverse effects? A) increased urine output B) deep Kussmaul respirations C) thirst and hot, flushed skin D) confusion and lack of coordination

Ans: D

Feedback: Antidiabetic medications decrease blood glucose levels. If levels fall too low, symptoms of hypoglycemia would include confusion and lack of coordination. Elevated blood glucose levels can occur when the client does not take the medications. With

58 Document shared on https://www.docsity.com/en/test-bank-for-karch-s-focus-on-nursing-pharmacology-9th-edition-by-rebecca-tucker/10381517/

inadequate dosage, hyperglycemia can occur, resulting in increased urination in an attempt to eliminate serum glucose, deep Kussmaul respirations to reduce blood pH by eliminating carbon dioxide, thirst, and hot, flushed skin.

Format: Multiple Choice Chapter: 3 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Difficult Integrated Process: Nursing Process Objective: 3 Page and Header: 42, Sensory Effects 8. A client is prescribed chloroquine for rheumatoid arthritis. What report by the client should the nurse interpret as a possible adverse reaction to the medication? A) “I have to urinate all the time.” B) “Sometimes I have blurred vision.” C) “I have tingling in my arms and legs.” D) “Sometimes I feel like I am off balance.”

Ans: B

Feedback: Chloroquine can cause ocular toxicity with blurring of vision, color vision changes, corneal damage, and blindness. Increased urination, tingling, and numbness are signs of hyperkalemia and hypokalemia. Loss of balance can be caused by auditory damage due to drug toxicity.

Format: Multiple Choice Chapter: 3 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate

59 Document shared on https://www.docsity.com/en/test-bank-for-karch-s-focus-on-nursing-pharmacology-9th-edition-by-rebecca-tucker/10381517/

Integrated Process: Nursing Process Objective: 5 Page and Header: 42, Neurological Effects 9. A client who regularly takes antihistamines for severe allergies is planning a tropical vacation. What health education related to drug therapy should the nurse provide? A) “Avoid sightseeing during the hottest part of the day.” B) “Discontinue the antihistamines if you feel restless.” C) “Decrease the dosage if you experience excessive thirst.” D) “Be very sure to wear a high-SPF sunscreen at all times.”

Ans: A

Feedback: Antihistamines can cause anticholinergic effects, which would result in decreased sweating and place the client at high risk for heat stroke. Avoiding the hottest part of the day will help prevent dehydration and heat prostration. Extreme restlessness could indicate Parkinson-like syndrome not usually associated with antihistamines. Excessive thirst is characteristic of hyperglycemia. Nurses should never tell clients to decrease or discontinue a drug unless the prescriber has instructed them to do so. Sun protection is necessary for all clients, but this is unrelated to antihistamine use.

Format: Multiple Choice Chapter: 3 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Easy Integrated Process: Teaching/Learning Objective: 1 Page and Header: 36, Adverse Effects 10. The caregiver of an older adult client diagnosed with ischemic heart disease tells the nurse that the client is only taking around half of the prescribed dosage of several medications. What possible effect should the nurse explain when providing health education?

60 Document shared on https://www.docsity.com/en/test-bank-for-karch-s-focus-on-nursing-pharmacology-9th-edition-by-rebecca-tucker/10381517/

A) increased risk of primary actions B) antibiotic resistance C) superinfection D) adverse effects

Ans: D

Feedback: Taking too little of the medication would mean that therapeutic levels are not being reached and the drugs will be less effective at lower dosages or even lead to adverse effects. Primary actions are the result of overdose, which is not the case in this client who is taking too little of the drug. Superinfection and eventual antibiotic resistance would only result if the client was taking an antibiotic, which is not indicated by the question.

Format: Multiple Choice Chapter: 3 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 1 Page and Header: 36, Adverse Effects; 37, Box 3.1 11. A client with Parkinson’s disease has been prescribed an anticholinergic medication. The client reports having difficulty voiding. How should the nurse interpret this finding? A) hypersensitivity to the drug B) the primary action of the drug C) an allergic action to the drug D) a secondary action of the drug

Ans: D Feedback: Sometimes the drug dosage can be adjusted so that the desired effect is achieved without producing undesired secondary reactions. But sometimes, this is not

61 Document shared on https://www.docsity.com/en/test-bank-for-karch-s-focus-on-nursing-pharmacology-9th-edition-by-rebecca-tucker/10381517/

possible, and the adverse effects are almost inevitable. In such cases, the client needs to be informed that these effects may occur and counseled about ways to cope with the undesired effects. The situation described is not a hypersensitivity reaction that would indicate an allergic reaction, a primary reaction that would be excessive therapeutic response, or an allergic reaction to the drug.

Format: Multiple Choice Chapter: 3 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Apply Difficulty: Moderate Integrated Process: Nursing Process Objective: 2 Page and Header: 36, Adverse Effects; 37, Box 3.1 12. The nurse is assessing a client new to the clinic. The client says they are allergic to penicillin. What action should the nurse take next? A) Assess the exact nature of the client’s response to the drug. B) Document that the client is allergic to penicillin. C) Perform a comprehensive health assessment. D) Continue to assess the client for other allergies.

Ans: A

Feedback: The nurse should ask additional questions to clients who state that they have a drug “allergy” to ascertain the exact nature of the response and whether it is a true drug allergy. Clients may confuse secondary actions of the drug with an allergy. The nurse is obliged to document the client’s statement and should assess the client, but the nurse should first gather more data about the nature of the client’s responses to penicillin. Format: Multiple Choice Chapter: 3 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies

62 Document shared on https://www.docsity.com/en/test-bank-for-karch-s-focus-on-nursing-pharmacology-9th-edition-by-rebecca-tucker/10381517/

Cognitive Level: Analyze Difficulty: Difficult Integrated Process: Nursing Process Objective: 3 Page and Header: 40, Toxicity 13. The nurse is assessing a client whose asthma is being treated with prednisone. What assessment finding should the nurse attribute to a possible adverse reaction? A) The client has an audible wheeze on expiration. B) The client’s blood glucose levels are 200 mg/dL (11.1 mmol/L). C) The client feels cold despite the room being warm. D) The client has not had a bowel movement for 3 days.

Ans: B

Feedback: Prednisone, a drug used as a corticosteroid that can be used to decrease inflammatory effects, can break down stored glycogen and cause an elevation of blood glucose by its effects on the sympathetic nervous system. Ephedrine does not cause bronchoconstriction, cold intolerance, or constipation.

Format: Multiple Selection Chapter: 3 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Easy Integrated Process: Caring Objective: 3 Page and Header: 43, Teratogenicity 14. The nurse should consider teratogenic effects when caring for what clients? Select all that apply. A) an 81-year-old male with chronic heart failure and peripheral edema B) a 41-year-old male who is immunocompromised following bone marrow transplant

63 Document shared on https://www.docsity.com/en/test-bank-for-karch-s-focus-on-nursing-pharmacology-9th-edition-by-rebecca-tucker/10381517/

C) a 44-year-old female being treated in the intensive care unit for multiorgan dysfunction syndrome D) a 29-year-old client receiving prenatal care in her first trimester of pregnancy E) a 37-year-old female client who is taking fertility drugs

Ans: D, E

Feedback: A teratogen is a drug that can harm the fetus or embryo so the nurse would consider the teratogenic properties of medications when caring for clients of childbearing age including adolescents and young adult women. Teratogens have no impact on clients who are not pregnant and who may not become pregnant.

Format: Multiple Choice Chapter: 3 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Analyze Difficulty: Moderate Integrated Process: Nursing Process Objective: 3 Page and Header: 38, Drug-Induced Tissue and Organ Damage 15. The nurse is caring for a client receiving an antineoplastic medication who reports fever, chills, sore throat, weakness, and back pain. The nurse should recognize the possibility of what adverse effect? A) dermatologic reaction B) blood dyscrasia C) electrolyte imbalance D) superinfection

Ans: B

Feedback: Symptoms of blood dyscrasias include fever, chills, sore throat, weakness, back pain, dark urine, decreased hematocrit (anemia), low platelet count

64 Document shared on https://www.docsity.com/en/test-bank-for-karch-s-focus-on-nursing-pharmacology-9th-edition-by-rebecca-tucker/10381517/

(thrombocytopenia), low white blood cell count (leukopenia), and a reduction of all cellular elements of the complete blood count (pancytopenia). Dermatologic reactions would be reflected in skin alterations, electrolyte imbalances would result in differing symptoms depending on the electrolyte involved but would not cause chills and fever, and a superinfection could cause a fever but would not cause a sore throat, weakness, or back pain unless the infection involved those body parts.

Format: Multiple Choice Chapter: 3 Client Needs: Physiological Integrity: Pharmacological and Parenteral Therapies Cognitive Level: Understand Difficulty: Easy Integrated Process: Nursing Process Objective: 31 Page and Header: 36, Adverse Effects 16. The nurse is caring for a client who is exhibiting adverse medication effects. The nurse should recognize that adverse effects can be extensions of what? A) the primary action of a drug B) anaphylaxis C) the secondary action of a drug D) an anticholinergic response to the drug

Ans: A

Feedback: Primary action adverse effects are extensions of the therapeutic action and are usually the result of overdosage, essentially too much of the therapeutic effect. Anaphylaxis is not an extension of the therapeutic action of the drug but a histamine reaction to an allergen. Secondary actions of a drug are negative effects of the drug that occur even when the drug is in the therapeutic range. Anticholinergic responses occur in response to drugs that block the parasympathetic nervous system.

65 Document shared on https://www.docsity.com/en/test-bank-for-karch-s-focus-on-nursing-pharmacology-9th-edition-by-rebecca-tucker/10381517/