2024
TEST BANK
Karch Focus on Nursing Pharmacology, 9th Edition
by Rebecca Tucker, All Chapters 1 - 59
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Table of Contents
Chapter 01- Introduction to Drugs
Chapter 02- Drugs and the Body
Chapter 03- Toxic Effects of Drugs
Chapter 04- The Nursing Process in Drug Therapy and Patient Safety
Chapter 05- Dosage Calculations
Chapter 06- Challenges to Effective Drug Therapy
Chapter 07- Introduction to Cell Physiology
Chapter 08- Anti-infective Agents
Chapter 09- Antibiotics
Chapter 10- Antiviral Agents
Chapter 11- Antifungal Agents
Chapter 12- Antiprotozoal Agents
Chapter 13- Anthelmintic Agents
Chapter 14- Antineoplastic Agents
Chapter 15- Introduction to the Immune Response and Inflammation
Chapter 16- Anti-inflammatory, Antiarthritis, and Related Agents
Chapter 17- Immune Modulators
Chapter 18- Vaccines and Sera
Chapter 19- Introduction to Nerves and the Nervous System
Chapter 20- Anxiolytic and Hypnotic Agents
Chapter 21- Antidepressant Agents
Chapter 22- Psychotherapeutic Agents
Chapter 23- Antiseizure Agents
Chapter 24- Antiparkinsonism Agents
Chapter 25- Muscle Relaxants
Chapter 26- Narcotics, Narcotic Antagonists, and Antimigraine Agents
Chapter 27- General and Local Anesthetic Agents
Chapter 28- Neuromuscular Junction Blocking Agents
Chapter 29- Introduction to the Autonomic Nervous System
Chapter 30- Adrenergic Agonists
Chapter 31- Adrenergic Antagonists
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Chapter 33- Anticholinergic Agents
Chapter 34- Introduction to the Endocrine System
Chapter 35- Hypothalamic and Pituitary Agents
Chapter 36- Adrenocortical Agents
Chapter 37- Thyroid and Parathyroid Agents
Chapter 38- Agents to Control Blood Glucose Levels
Chapter 39- Introduction to the Reproductive System
Chapter 40- Drugs Affecting the Female Reproductive System
Chapter 41- Drugs Affecting the Male Reproductive System
Chapter 42- Introduction to the Cardiovascular System
Chapter 43- Drugs Affecting Blood Pressure
Chapter 44- Agents for Treating Heart Failure
Chapter 45- Antiarrhythmic Agents
Chapter 46- Antianginal Agents
Chapter 47- Lipid-Lowering Agents
Chapter 48- Drugs Affecting Blood Coagulation
Chapter 49- Drugs Used to Treat Anemias
Chapter 50- Introduction to the Renal System
Chapter 51- Diuretic Agents
Chapter 52- Drugs Affecting the Urinary Tract and the Bladder Chapter
53- Introduction to the Respiratory System
Chapter 54- Drugs Acting on the Upper Respiratory Tract
Chapter 55-Drugs Acting on the Lower Respiratory Tract
Chapter 56- Introduction to the Gastrointestinal System
Chapter 57- Drugs Affecting Gastrointestinal Secretions
Chapter 58- Drugs Affecting Gastrointestinal Motility
Chapter 59- Antiemetic Agents
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Chapter 1: Introduction to Drugs
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Nursing process
1.A nurse working in radiology administers iodine to a patient who is having a
computerized axial tomography (CAT) scan. A nurse working on an oncology unit
administers chemotherapy to patients 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
Response:
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 nurse working in radiology is administering a drug to help diagnose a
disease. The nurse working on an oncology unit 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 drug.
Cognitive Level: Comprehension
Difficulty: Easy
Integrated Process: Nursing process
2.A physician has ordered intramuscular injections of morphine, a narcotic, every 4
hours as needed for pain for a motor vehicle accident victim. The nurse is aware that
there is a high abuse potential for this drug; therefore, morphine is categorized as a:
A) Schedule I drug
B) Schedule II drug
C) Schedule III drug
D) Schedule IV drug
Ans: B
Response:
Narcotics such as morphine are considered schedule II drugs because of the high
abuse potential with 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.
Cognitive Level: Comprehension
Difficulty: Easy
Integrated Process: Communication and documentation
3.A nurse working for a drug company is involved in phase III drug evaluation studies.
Which of the following might the nurse be responsible for during this stage of drug
development?
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Chapter 1: Introduction to Drugs
A) Working with animals who are given experimental drugs
B) Monitoring drug effects in patients who are selected to participate in a study,
who have the disease that the drug is meant to treat
C) Collecting records of symptoms that participants experience while taking a
drug and determining whether they are caused by the disease or the drug
D) Informing healthy, young volunteer participants of possible risks that could
occur from taking an experimental drug
Ans: C
Response:
Phase III studies involve use of a drug in a vast clinical market where patients are
asked to record any symptoms they experience while taking the drugs. Nurses may be
responsible for helping collect and analyze the information to be shared with the
Food and Drug Administration (FDA). Use of animals in drug testing is done in the
preclinical trials. A select group of patients who are involved in phase II studies
participate in studies where the participants have the disease the drug is intended to
treat. These patients are monitored closely for drug effects. Phase I studies involve
healthy human volunteers who are usually paid for their participation. Nurses may
observe for adverse effects and toxicity.
Cognitive Level: Comprehension
Difficulty: Moderate
Integrated Process: Nursing Process
4.Which of the following concepts is considered when generic drugs are substituted for
brand-name drugs?
A) Bioavailability
B) Critical concentration
C) Distribution
D) Half-life
Ans: A
Response:
Bioavailability is the portion of a dose of a drug that reaches the systemic circulation
and is available to act on body cells. 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 substitution. Critical
concentration is the amount of a drug that is needed to cause a therapeutic effect.
Distribution is the phase of pharmacokinetics that involves the movement of a drug to
the body's tissues. A drug's half-life is the time it takes for the amount of drug to
decrease to one-half of the peak level.
Cognitive Level: Analysis
Difficulty: Difficult
Integrated Process: Teaching/learning
5.A nurse is teaching her patient about the use of over-the-counter (OTC) drugs. Which
of the following statements best informs the patient about their safe use?
A) OTC drugs are products that are available without prescription for self-
treatment of minor complaints.
B) OTC drugs are considered medications and should be reported on a drug
history.
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Chapter 1: Introduction to Drugs
C) OTC drugs were approved as prescription drugs but later were found to be
safe without the need for a prescription.
D) OTC drugs need to be taken with caution. They can mask the signs and
symptoms of an underlying disease and interfere with prescription drug
therapy.
Ans: D
Response:
OTC drugs are considered medications and should be reported. OTC drugs are
available without a prescription, although some were first approved as prescription
drugs. The most important teaching should relate to their safe use and that OTC drugs
can mask symptoms of disease and interfere with prescribed drugs.
Cognitive Level: Knowledge
Difficulty: Easy
Integrated Process: Nursing Process
6.Which of the following legislative acts allowed the Food and Drug Administration
(FDA) to tighten control over the quality of drugs and required that safety and
efficacy standards be established?
A) Pure Food and Drug Act of 1906
B) Federal Food, Drug, and Cosmetic Act of 1938
C) Durham Humphrey Amendment of 1951
D) Kefauver-Harris Act of 1962
Ans: D
Response:
The Kefauver-Harris Act was the result of the use of the 1960s drug thalidomide
(Thalomid). The public concern led to the legislation that gave the FDA regulatory
control over testing and evaluating of drugs and allowed it to set standards for
efficacy and safety. The Pure Food and Drug Act required labeling to eliminate false
claims. The Federal Food, Drug, and Cosmetic Act gave the FDA the power to
enforce standards for testing drug toxicity and monitoring labeling. The Durham-
Humphrey Amendment enforced prescriptions for distribution.
Cognitive Level: Application
Difficulty: Moderate
Integrated Process: Teaching/learning
7.A nurse is instructing a pregnant patient concerning the potential risk to her fetus
from a pregnancy category B drug. The nurse would inform the patient that:
A) Adequate studies in pregnant women have demonstrated there is no risk to the
fetus.
B) Animal studies have not demonstrated a risk to the fetus but there have been
no adequate studies in pregnant women.
C) Animal studies have shown an adverse effect on the fetus but there are no
adequate studies in pregnant women.
D) There is evidence of human fetal risk but the potential benefits from use of the
drug may be acceptable despite potential risks.
Ans: B
Response:
Category B indicates that animal studies have not demonstrated a risk to the fetus but
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Chapter 1: Introduction to Drugs
there have been no adequate studies in pregnant women. However, there have not
been adequate studies in pregnant women to demonstrate risk to a fetus during the
first trimester of pregnancy and no evidence of risk in later trimesters. Category A
indicates that adequate studies in pregnant women have not demonstrated a risk to the
fetus in the first trimester or in later trimesters. Category C indicates that animal
studies have shown an adverse effect on the fetus but there have been no adequate
studies in humans. Category D reveals evidence of human fetal risk, but the potential
benefits from the use of the drugs in pregnant women may outweigh the risks.
Cognitive Level: Analysis
Difficulty: Difficult
Integrated Process: Teaching/learning
8. Discharge planning for patients leaving the hospital should include instructions on
the use of over-the-counter (OTC) drugs. Which comment by the patient would
demonstrate a good understanding of OTC drugs?
A) OTC drugs are always safe and will not cause bad effects.
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 are thought to be safe when taken as directed.
Ans: D
Response:
OTC drugs are drugs that have been determined to be safe when taken as directed.
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.
Cognitive Level: Comprehension
Difficulty: Moderate
Integrated Process: Teaching/Learning
9. Which of the following would be the best source of drug information for a nurse?
A) Drug Facts and Comparisons book
B) A nurse's drug guide
C) A drug package insert
D) The Physician's Drug Reference (PDR)
Ans: B
Response:
The most user-friendly drug source for a nurse is a nurse's drug guidebook. A guide
provides nursing implications and patient teaching points that are most useful to
nurses. The Drug Facts and Comparisons book provides a wide range of drug
information but is hard to manipulate and is very expensive. A package insert
contains all of the chemical and drug company research information about a drug;
however, the information can be difficult to understand and the print is very small.
The PDR is heavily cross-referenced and difficult to use.
Cognitive Level: Comprehension
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Chapter 1: Introduction to Drugs
Difficulty: Moderate
Integrated Process: Nursing Process
10. Which of the following statements best defines how a chemical becomes a drug?
A) A chemical must have a proven therapeutic value or efficacy without severe
toxicity or damaging properties to become a drug.
B) A chemical becomes a drug when it is introduced into the body to cause a
change.
C) A chemical is considered a drug when the Food and Drug Administration
(FDA) approves its release to be marketed.
D) A chemical must have demonstrated therapeutic value to become a drug.
Ans: A
Response:
A chemical must undergo a series of tests to determine its therapeutic value and
efficacy without severe toxicity or damaging properties before it is termed a drug.
Test results are reported to the FDA, which may or may not give approval.
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Chapter 2: Drugs and the Body
Cognitive Level: Analysis
Difficulty: Difficult
Integrated Process: Nursing process
1. In which of the following patients would a nurse expect to see an alteration in drug
metabolism?
A) A 35-year-old female with cervical cancer
B) A 41-year-old male with kidney stones
C) A 50-year-old male with cirrhosis of the liver
D) A 62-year-old female in acute renal failure
Ans: C
Response:
The liver is the most important site of drug metabolism. If the liver is not functioning
effectively, as in patients with cirrhosis, drugs will not be metabolized normally and
toxic levels could develop. In cirrhosis patients the drug dosage will need to be
altered to ensure normal levels in the body.
Cognitive Level: Analysis
Difficulty: Difficult
Integrated Process: Nursing process
2.A patient has a drug level of 50 units/mL and the drug's half-life is 1 hour. If
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?
A) 30 minutes
B) 1 hour
C) 2 hours
D) 3 hours
Ans: C
Response:
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). After 2
hours, the serum concentration would be 12.5 units/mL (25/2) and reach the nontoxic
range.
Cognitive Level: Analysis
Difficulty: Difficult
Integrated Process: Nursing process
3.A nurse is caring for a patient who has recently moved from Vermont to south
Florida. The patient has been on the same antihypertensive drug for 6 years and has
had stable blood pressures and no side effects. Since her move, however, she reports
having dizzy spells and weakness and feels that the drug is no longer effective. The
nurse knows that one possible reason for the change in the effectiveness of the drug
could be which of the following?
A) The impact of the placebo effect on the patient's response
B) The accumulative effect of the drug if it has been taken for many years
C) The impact of the warmer environment on the patient's physical state
D) Problems with patient compliance with the drug regimen while on vacation
Ans: C
Response:
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Chapter 2: Drugs and the Body
Antihypertensive drugs work to decrease the blood pressure. When a patient goes to a
climate that is much warmer than usual, blood vessels dilate and the blood pressure
falls. If a patient is taking an antihypertensive drug and enters a warmer climate,
there is a chance that the patient's blood pressure will drop too low, resulting in
dizziness and feelings of weakness. Most antihypertensives are metabolized and
excreted and do not accumulate in the body. Patients must be very compliant with
their drug regimen while on vacation. After several years on an antihypertensive
drug, the effects of that drug are known; therefore, the placebo effect should not be
an issue.
Cognitive Level: Comprehension
Difficulty: Moderate
Integrated Process: Nursing Process
4. During which phase of pharmacokinetics could a significant drug-drug interaction
occur, resulting in one drug stimulating or blocking the metabolism of the other drug?
A) Absorption
B) Distribution
C) Biotransformation
D) Excretion
Ans: C
Response:
During biotransformation, a drug may be metabolized quicker if taken at the same
time as another drug, and higher doses of the drug will be needed to achieve the
desired effect. During absorption, one drug can prevent or accelerate absorption of
the other drug. During distribution, one drug competes for the protein-binding site of
another drug so the second drug cannot be transported to the reactive tissue. During
excretion, one drug competes for excretion with the other drug, leading to
accumulation and toxic effects of one of the drugs.
Cognitive Level: Comprehension
Difficulty: Moderate
Integrated Process: Nursing Process
5. Which statement accurately describes a drug agonist?
A) A drug that reacts with specific receptor sites on a cell and prevents the
reaction of another chemical with a different receptor site on that cell
B) A drug that interferes with the enzyme systems that act as catalysts for different
chemical reactions
C) A drug that interacts directly with receptor sites to cause the same activity that
a natural chemical would cause at that site
D) A drug that reacts with receptor sites to block normal stimulation, producing no
effect
Ans: C
Response:
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 certain receptor sites,
preventing the reaction of another chemical with a different receptor site. Drug-
enzyme interactions interfere with the enzyme systems that stimulate various
