Pharmacology for the Primary Care Provider 4th Edition By Edmunds-Test Bank

Chapter 1: Drug Action: Pharmaceutic, Pharmacokinetic, and Pharmacodynamic Phases

Test Bank

MULTIPLE CHOICE

1. A nurse is providing an oral medication for pain relief to a client. To attain the fastest pain relief, the nurse administers the medication so that it is most rapidly absorbed from the gastrointestinal (GI) tract. Which mode of delivery has the fastest absorption?
a. Tablet
b. Enteric-coated pill
c. Capsule
d. Liquid suspension

ANS: D
Drugs must be in solution to be absorbed in the gastrointestinal tract. Because liquid drugs are already in solution, they are absorbed faster than drugs in a solid form.

DIF: Cognitive Level: Application REF: p. 3
TOP: Nursing Process: Intervention/Implementation
MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

2. A client asks why she needs to take a medication on an empty stomach. The nurse explains that food generally has which effect on drug dissolution and absorption?
a. Enhances
b. Increases
c. Decreases
d. Does not have an effect

ANS: C
Food in the GI tract can interfere with the dissolution and absorption of some drugs. However, there are specific drugs that should be taken with food to enhance absorption.

DIF: Cognitive Level: Application REF: p. 4
TOP: Nursing Process: Intervention/Teaching
MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

3. Biotransformation is affected by many factors. What happens to the client’s drug metabolism when liver function is decreased?
a. The client can develop toxicity.
b. The client will have an enhanced therapeutic response.
c. The client may require a larger than normal dose of the medication.
d. The client will experience a decreased therapeutic response.

ANS: A
When the drug metabolism rate is decreased, excess drug accumulation can occur and lead to the client’s developing toxicity. The GI membrane is made up of lipids; therefore, lipid medications are most easily absorbed across the digestive membrane of the stomach. Medications that are nonionized (neither positive nor negative) also pass through the GI membrane faster than those with a charge.

DIF: Cognitive Level: Application REF: p. 6
TOP: Nursing Process: Analysis
MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

4. A client asks why the oral dose of her pain medication is higher than the intravenous dose. The nurse explains that with the oral dose, only 20% to 40% of the drug may actually enter systemic circulation. This reduces the amount of active drug. What is the term for this effect?
a. Protein binding
b. Bioavailability
c. Hepatic first pass
d. Pinocytosis

ANS: B
Bioavailability is the percentage of the administered drug dose that reaches the systemic circulation. Oral drugs that have a high first-pass hepatic metabolism may have a bioavailability of only 20% to 40% on entering systemic circulation. To obtain the desired drug effect, the oral dose could be three to five times larger than the drug dose for IV use.

DIF: Cognitive Level: Comprehension REF: p. 4
TOP: Nursing Process: Analysis
MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

5. When providing a medication, which route should the nurse select to ensure the maximum amount of bioavailability?
a. Oral
b. Intravenous
c. Intramuscular
d. Subcutaneous

ANS: B
The percentage of bioavailability for the oral route is always less than 100%, but for the intravenous route it is usually 100%.

DIF: Cognitive Level: Comprehension REF: p. 4
TOP: Nursing Process: Analysis
MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

6. A client is being given two highly protein-bound drugs concurrently. What is most likely to be the result of this administration?
a. More free drug in circulation
b. Less free drug in circulation
c. More drug bound to protein
d. More drug excreted in the urine

ANS: A
When two highly protein-bound drugs are given concurrently, they compete for protein-binding sites, causing more free drug to be released into the circulation. Drug accumulation and possible drug toxicity can result.

DIF: Cognitive Level: Application REF: p. 5
TOP: Nursing Process: Analysis
MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

7. A client is taking a drug that is moderately highly protein bound. Several days later, the client takes a second drug that is 90% protein bound. What is most likely to have occurred as a result of this administration?
a. The first drug remains protein bound.
b. The first drug becomes increasingly inactive.
c. The first drug is released from the protein and becomes more pharmacologically active.
d. The second drug becomes more active.

ANS: C
Only drugs not bound to protein are active and can cause a pharmacologic response. As the free drug in the circulation decreases, more bound drug is released from the protein to maintain the balance of free drug.

DIF: Cognitive Level: Application REF: p. 5
TOP: Nursing Process: Active
MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

8. A nurse is determining whether a medication is ordered to be given at the appropriate intervals. This is done by assessing the half-life of the medication. The serum half-life (t) of a drug is the time required:
a. for half of a drug dose to be absorbed.
b. after absorption for half of the drug to be eliminated.
c. for a drug to be achieve maximum effectiveness.
d. for half of the drug dose to be completely distributed.

ANS: B
The half-life (t) of a drug is the time it takes for one half of the drug concentration to be eliminated.

DIF: Cognitive Level: Comprehension REF: pp. 5-6
TOP: Nursing Process: Analysis
MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

9. A client is to receive a drug that has a half-life of 36 hours. The drug would probably be administered on which dose schedule?
a. Once a week
b. Once a day
c. Twice a day
d. Three times a day

ANS: B
Since the medication requires 36 hours to be eliminated from the body, a once-daily dosing pattern would allow therapeutic drug levels to be maintained.

DIF: Cognitive Level: Analysis REF: pp. 5-6
TOP: Nursing Process: Analysis
MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

10. A client is suffering from end-stage renal disease. Because of this condition, the nurse monitors drug levels to assess for which phenomenon?
a. Toxicity
b. Subtherapeutic levels
c. Drug ineffectiveness
d. Poor compliance

ANS: A
The primary route for drug elimination is the renal system. If kidney function is impaired, drugs may reach toxic levels.

DIF: Cognitive Level: Comprehension REF: pp. 6-7
TOP: Nursing Process: Analysis
MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies