KARCH’S FOCUS ON NURSING
PHARMACOLOGY
10TH EDITION
• AUTHOR(S)REBECCA G. TUCKER
TEST BANK
1)
Reference: Ch. 1 — Introduction to Drugs
Stem: A 68-year-old patient is admitted with new confusion and
a recent start of a benzodiazepine for insomnia prescribed by a
clinic. Vital signs are stable. The nurse reviews the medication
list and notes the benzodiazepine is not on the patient’s prior
list. What should the nurse do first?
A. Ask the patient to describe when and why the
benzodiazepine was started.
B. Contact the prescriber to request discontinuation of the
benzodiazepine.
,C. Perform a focused assessment of neurological status (LOC,
orientation, fall risk).
D. Administer activated charcoal in case of overdose.
Correct Answer: C
Rationale — Correct (C): The nurse’s immediate responsibility is
assessment. New confusion with a recently started central
nervous system (CNS) depressant requires focused neurologic
assessment to determine severity and fall risk prior to any
medication changes. Karch emphasizes assessment before
intervention to guide safe clinical decision-making.
Rationale — Incorrect (A): Useful, but secondary; immediate
safety requires objective assessment rather than only patient
report.
Rationale — Incorrect (B): Premature without assessment data;
prescriber contact follows nursing assessment and
communication of findings.
Rationale — Incorrect (D): Activated charcoal is not appropriate
for a therapeutic benzodiazepine dose and is not first-line in this
scenario.
Teaching point: Always assess neurological status first when
new CNS depression is suspected.
Citation: Tucker, R. G. (2026). Karch’s Focus on Nursing
Pharmacology (10th ed.). Ch. 1.
2)
,Reference: Ch. 1 — Introduction to Drugs
Stem: A patient with chronic kidney disease stage 4 is
prescribed a drug primarily excreted unchanged by the kidneys.
During medication reconciliation, which nurse action best
reflects pharmacokinetic principles?
A. Give the medication as prescribed and monitor blood
pressure.
B. Hold the medication until a pharmacist can adjust the dose
based on renal function.
C. Administer the medication and request the prescriber write a
urine output goal.
D. Substitute an over-the-counter alternative without prescriber
notification.
Correct Answer: B
Rationale — Correct (B): Renal impairment alters drug
excretion — dosing adjustments or alternative agents may be
required to avoid accumulation and toxicity. The nurse should
withhold until appropriate dose adjustment is confirmed, per
Karch’s focus on excretion and dose individualization.
Rationale — Incorrect (A): Administering without adjustment
risks toxicity; monitoring BP alone ignores renal elimination.
Rationale — Incorrect (C): Urine output goals don’t correct
need for dose adjustment; clinical action should address
pharmacokinetics.
Rationale — Incorrect (D): Substituting without
, prescriber/pharmacist input is unsafe and outside nursing
scope.
Teaching point: Adjust doses for impaired excretion—verify
with prescriber/pharmacist.
Citation: Tucker, R. G. (2026). Karch’s Focus on Nursing
Pharmacology (10th ed.). Ch. 1.
3)
Reference: Ch. 1 — Introduction to Drugs
Stem: The nurse is teaching a patient starting a new oral
antibiotic that has reduced bioavailability when taken with
antacids. Which teaching point most directly addresses
bioavailability?
A. “Take the antibiotic with a glass of juice to ease GI upset.”
B. “Take the antibiotic 2 hours before or after antacid use.”
C. “If you miss a dose, double the next dose.”
D. “Stop antacid use permanently while on this antibiotic.”
Correct Answer: B
Rationale — Correct (B): Bioavailability refers to how much of
an oral drug reaches systemic circulation. Antacids can chelate
or alter gastric pH and reduce absorption; separating dosing by
2 hours is a practical nursing teaching point to optimize
bioavailability.
Rationale — Incorrect (A): Juice may interact with some drugs
but doesn’t address antacid interaction specifically.
PHARMACOLOGY
10TH EDITION
• AUTHOR(S)REBECCA G. TUCKER
TEST BANK
1)
Reference: Ch. 1 — Introduction to Drugs
Stem: A 68-year-old patient is admitted with new confusion and
a recent start of a benzodiazepine for insomnia prescribed by a
clinic. Vital signs are stable. The nurse reviews the medication
list and notes the benzodiazepine is not on the patient’s prior
list. What should the nurse do first?
A. Ask the patient to describe when and why the
benzodiazepine was started.
B. Contact the prescriber to request discontinuation of the
benzodiazepine.
,C. Perform a focused assessment of neurological status (LOC,
orientation, fall risk).
D. Administer activated charcoal in case of overdose.
Correct Answer: C
Rationale — Correct (C): The nurse’s immediate responsibility is
assessment. New confusion with a recently started central
nervous system (CNS) depressant requires focused neurologic
assessment to determine severity and fall risk prior to any
medication changes. Karch emphasizes assessment before
intervention to guide safe clinical decision-making.
Rationale — Incorrect (A): Useful, but secondary; immediate
safety requires objective assessment rather than only patient
report.
Rationale — Incorrect (B): Premature without assessment data;
prescriber contact follows nursing assessment and
communication of findings.
Rationale — Incorrect (D): Activated charcoal is not appropriate
for a therapeutic benzodiazepine dose and is not first-line in this
scenario.
Teaching point: Always assess neurological status first when
new CNS depression is suspected.
Citation: Tucker, R. G. (2026). Karch’s Focus on Nursing
Pharmacology (10th ed.). Ch. 1.
2)
,Reference: Ch. 1 — Introduction to Drugs
Stem: A patient with chronic kidney disease stage 4 is
prescribed a drug primarily excreted unchanged by the kidneys.
During medication reconciliation, which nurse action best
reflects pharmacokinetic principles?
A. Give the medication as prescribed and monitor blood
pressure.
B. Hold the medication until a pharmacist can adjust the dose
based on renal function.
C. Administer the medication and request the prescriber write a
urine output goal.
D. Substitute an over-the-counter alternative without prescriber
notification.
Correct Answer: B
Rationale — Correct (B): Renal impairment alters drug
excretion — dosing adjustments or alternative agents may be
required to avoid accumulation and toxicity. The nurse should
withhold until appropriate dose adjustment is confirmed, per
Karch’s focus on excretion and dose individualization.
Rationale — Incorrect (A): Administering without adjustment
risks toxicity; monitoring BP alone ignores renal elimination.
Rationale — Incorrect (C): Urine output goals don’t correct
need for dose adjustment; clinical action should address
pharmacokinetics.
Rationale — Incorrect (D): Substituting without
, prescriber/pharmacist input is unsafe and outside nursing
scope.
Teaching point: Adjust doses for impaired excretion—verify
with prescriber/pharmacist.
Citation: Tucker, R. G. (2026). Karch’s Focus on Nursing
Pharmacology (10th ed.). Ch. 1.
3)
Reference: Ch. 1 — Introduction to Drugs
Stem: The nurse is teaching a patient starting a new oral
antibiotic that has reduced bioavailability when taken with
antacids. Which teaching point most directly addresses
bioavailability?
A. “Take the antibiotic with a glass of juice to ease GI upset.”
B. “Take the antibiotic 2 hours before or after antacid use.”
C. “If you miss a dose, double the next dose.”
D. “Stop antacid use permanently while on this antibiotic.”
Correct Answer: B
Rationale — Correct (B): Bioavailability refers to how much of
an oral drug reaches systemic circulation. Antacids can chelate
or alter gastric pH and reduce absorption; separating dosing by
2 hours is a practical nursing teaching point to optimize
bioavailability.
Rationale — Incorrect (A): Juice may interact with some drugs
but doesn’t address antacid interaction specifically.
