6. Chapter 6: Drug Interactions
7. Chapter 7: Adverse Drug Reactions and Medication Errors
8. Chapter 8: Individual Variation in Drug Responses
9. Chapter 9: Drug Therapy During Pregnancy and Breast-Feeding
10. Chapter 10: Drug Therapy in Pediatric Patients
TEST BANK LEHNE’S PHARMACOLOGY
CHAPTERS 06-10
Chapter 6: Drug Interactions
MULTIPLE CHOICE
1. The nurse is teaching a patient about taking warfarin and asks if the patient takes aspirin.
This assessment by the nurse reflects a knowledge of which type of drug interaction?
a. Creation of unique effects
b. Increased therapeutic effects
c. Inhibitory effects
d. Potentiative effects
ANS: D
A potentiative effect is one in which one drug intensifies the effects of another. Both
warfarin and aspirin suppress blood clotting, and the combination may increase the
risk of bleeding, which is an intensified adverse effect. Creation of a unique effect is a
rare occurrence in which the combination of two drugs creates a response not seen
with either drug when given alone. Increased therapeutic effects are a type of
potentiative effect; however, in this case the combination of two drugs would increase
the desired effects. An inhibitory effect is a type of pharmacodynamic effect that
occurs when an antagonist drug inhibits the action of an agonist drug at the same
receptor site.
DIF: Cognitive Level: Application REF: Consequences of Drug-Drug
Interactions; also Pharmacodynamic Interactions TOP: Nursing Process:
Assessment MSC: NCLEX Client Needs Category: Physiologic Integrity:
Reduction of Risk Potential
2. A young adult postoperative patient is receiving morphine 2 to 4 mg IV every 2 hours
PRN pain. The last dose was 3 mg given 2 hours ago. The patient is asleep, and the nurse
notes a heart rate of 86 beats per minute and a respiratory rate of 8 breaths per minute.
Which PRN medication will the nurse give this patient?
a. Diphenhydramine (Benadryl) to counter morphine side effects
b. Morphine 4 mg for increased pain, as indicated by tachycardia
c. Naloxone (Narcan) to block the effects of the morphine
d. Nothing at this time, because the patient is resting comfortably
ANS: C
respiratory rate of 8 breaths per minute indicates respiratory depression, which is a
, significant adverse effect indicating morphine toxicity. Naloxone blocks the actions of
morphine at cell receptor sites and is given to quickly reverse the effects. This patient
does not have signs of an allergic response, which would include shortness of breath,
a rapid respiratory rate, and wheezing. The tachycardia might be a sign of worsening
pain, but the toxic effects must be treated first. Patients who are sleeping are not
always pain free.
DIF: Cognitive Level: Analysis REF: Pharmacodynamic Interactions
TOP: Nursing Process: Evaluation MSC: NCLEX Client Needs
Category: Physiologic Integrity: Reduction of Risk Potential
3. In a discussion of drug-drug interactions, which would be the best example of a beneficial
inhibitory interaction?
a. Naloxone (Narcan) blocking morphine sulfate’s actions
b. Antacids blocking the action of tetracycline (Sumycin)
c. Alcohol blocking the actions of opioids
d. Cholestyramine blocking the actions of antihypertensive drugs
ANS: A
Naloxone is used when a narcotic overdose has occurred. As a narcotic antagonist, it
provides a beneficial inhibitory interaction. An antacid blocking tetracycline’s
antibiotic effects would not be beneficial, but rather detrimental to the desired effects
of the tetracycline. Alcohol would not block the effects of opiates, but would
contribute to CNS depression. Cholestyramine and certain other adsorbent drugs,
which are administered orally but do not undergo absorption, can adsorb other drugs
onto themselves, thereby preventing absorption of the other drugs into the blood.
DIF: Cognitive Level: Application REF: Pharmacodynamic
Interactions TOP: Nursing Process: Implementation MSC: NCLEX
Client Needs Category: Physiologic Integrity: Reduction of Risk Potential
4. A patient is taking drug X and receives a new prescription for drug Y, which is listed as
an inducing agent. The nurse caring for this patient understands that this patient may
require ____ doses of drug ____.
a. lower; X
b. lower; Y
c. higher; X
d. higher; Y
ANS: C
An inducing agent stimulates the synthesis of CYP isozymes, which may increase the
metabolism of other drugs as much as two- to threefold, thereby lowering the level of
those drugs in the body and requiring higher doses to maintain drug effectiveness.
DIF: Cognitive Level: Application REF: Reduction of Effects:
Altered Metabolism TOP: Nursing Process: Planning MSC: NCLEX
Client Needs Category: Physiologic Integrity: Pharmacologic and Parenteral
, Therapies
5. A patient taking oral contraceptives thinks she may be pregnant. As part of this patient’s
history, what will the nurse ask the patient?
a. “Do you drink grapefruit juice?”
b. “Do you take seizure medication?”
c. “Do you take your contraception with milk?”
d. “Do you use laxatives regularly?”
ANS: B
Patients taking oral contraceptives along with phenobarbital, which is used to treat
seizures, will have lower levels of the contraceptive, because phenobarbital is an
inducing agent, which causes an increase in the metabolism of oral contraceptives.
Grapefruit juice inhibits the metabolism of some drugs, leading to toxic effects. Dairy
products interfere with the absorption of tetracyclines, because the calcium binds with
the drug to form an insoluble complex. Laxatives reduce the absorption of some drugs
by speeding up the transit time through the gut
DIF: Cognitive Level: Analysis REF: Pharmacokinetic Interactions,
Metabolism | Drug-Food Interactions TOP: Nursing Process: Diagnosis
MSC: NCLEX Client Needs Category: Physiologic Integrity:
Reduction of Risk Potential
6. A child ingests a parent’s aspirin tablets, and the prescriber orders sodium bicarbonate to
block the toxic effects of the aspirin. The nurse caring for this patient knows that sodium
bicarbonate is effective against the aspirin because it:
a. accelerates its passage through the intestine.
b. alters urinary pH to enhance renal excretion.
c. induces CYP isozymes to increase drug metabolism.
d. raises the pH of the interstitial fluid to facilitate passage out of the cells.
ANS: D
Sodium bicarbonate increases the pH of interstitial fluid and plasma, allowing the
acidic aspirin ions to move outside the cells and thus removing them from the site
where they have toxic effects. It does not have laxative effects and does not alter the
rate of passage through the gut. It is not a CYP isozyme inducer and therefore has no
effect on drug metabolism. It does not alter renal excretion of aspirin.
DIF: Cognitive Level: Application REF: Pharmacokinetic Interactions:
Altered Distribution: Alteration of Extracellular pH TOP: Nursing Process:
Implementation MSC: NCLEX Client Needs Category: Physiologic
Integrity: Reduction of Risk Potential
7. Which statement about food and drug interactions is true?
a. Foods alter drug absorption and metabolism but not drug action.
b. Medications are best absorbed on an empty stomach.
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