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 inpatient with reduced renal function (CrCl
25 mL/min) has a new order for a medication that is primarily
renally excreted. The nurse notes the order does not include a
dosage adjustment. Which action should the nurse take first?
A. Administer the drug as ordered and monitor renal labs in 48
hours.
B. Hold the medication and contact the prescriber to clarify
dose for renal impairment.
C. Ask pharmacy to send an alternate drug that is hepatically
,metabolized.
D. Give half the dose now and document the rationale in the
chart.
Correct answer: B
Rationale — Correct (B): Holding and contacting the prescriber
is the safest first action. Karch emphasizes assessing
pharmacokinetics (excretion) and clarifying orders when patient
factors (low CrCl) may require dose adjustment to avoid toxicity.
This prioritizes patient safety and clarifies prescriber intent
before administration.
Rationale — Incorrect:
A. Monitoring without first clarifying risks immediate drug
accumulation/toxicity.
C. Requesting an alternative without prescriber approval
bypasses scope and may delay therapy.
D. Arbitrarily reducing dose is unsafe and not standard practice
without prescriber/pharmacy collaboration.
Teaching point: Clarify dose/orders before giving medications to
patients with impaired elimination.
Citation: Tucker, R. G. (2026). Karch’s Focus on Nursing
Pharmacology (10th ed.). Ch. 1.
2) Reference
Ch. 1 — Introduction to Drugs
,Stem: A nurse prepares to give a PRN opioid to a postoperative
patient complaining of severe pain. The patient’s pulse oximetry
reads 89% on room air and respiratory rate is 8 breaths/min.
What should the nurse do first?
A. Offer additional nonpharmacologic pain measures and
withhold opioid until respiratory status improves.
B. Administer the opioid and titrate dose for comfort; monitor
oxygen saturation frequently.
C. Increase the oxygen flow and then give the opioid to ensure
adequate oxygenation.
D. Call the prescriber to request a benzodiazepine instead for
anxiety to reduce perceived pain.
Correct answer: A
Rationale — Correct (A): With evidence of hypoventilation and
hypoxia, Karch’s principles prioritize patient safety: withhold
respiratory-depressant opioids and first use
nonopioid/nonpharmacologic measures while addressing
oxygenation and notifying the provider. Treating respiratory
compromise takes precedence.
Rationale — Incorrect:
B. Giving an opioid risks worsening hypoventilation and hypoxia.
C. Increasing oxygen without addressing respiratory depression
and withholding opioid still leaves risk; oxygen alone doesn't
correct low ventilation.
D. Benzodiazepines also depress respiration and would worsen
the problem.
, Teaching point: Withhold respiratory-depressant drugs in
hypoventilating, hypoxic patients; prioritize airway/oxygenation.
Citation: Tucker, R. G. (2026). Karch’s Focus on Nursing
Pharmacology (10th ed.). Ch. 1.
3) Reference
Ch. 1 — Introduction to Drugs
Stem: A newly admitted patient lists several over-the-counter
herbal supplements. Which nursing action best addresses
potential drug–herbal interactions before administering
prescribed medications?
A. Document the supplements in the chart and proceed with
the medication schedule.
B. Instruct the patient to stop all supplements immediately
without discussing with the prescriber.
C. Ask for specifics (names, doses) and notify the
prescriber/pharmacy to evaluate interactions.
D. Tell the patient that herbs are natural and unlikely to interact
with prescription drugs.
Correct answer: C
Rationale — Correct (C): Karch highlights medication
reconciliation and identification of all substances (including
herbal) because many interact with prescription drugs.
Gathering specifics and involving prescriber/pharmacy enables
safe, evidence-based decisions.
PHARMACOLOGY
10TH EDITION
• AUTHOR(S)REBECCA G. TUCKER
TEST BANK
1) Reference
Ch. 1 — Introduction to Drugs
Stem: A 68-year-old inpatient with reduced renal function (CrCl
25 mL/min) has a new order for a medication that is primarily
renally excreted. The nurse notes the order does not include a
dosage adjustment. Which action should the nurse take first?
A. Administer the drug as ordered and monitor renal labs in 48
hours.
B. Hold the medication and contact the prescriber to clarify
dose for renal impairment.
C. Ask pharmacy to send an alternate drug that is hepatically
,metabolized.
D. Give half the dose now and document the rationale in the
chart.
Correct answer: B
Rationale — Correct (B): Holding and contacting the prescriber
is the safest first action. Karch emphasizes assessing
pharmacokinetics (excretion) and clarifying orders when patient
factors (low CrCl) may require dose adjustment to avoid toxicity.
This prioritizes patient safety and clarifies prescriber intent
before administration.
Rationale — Incorrect:
A. Monitoring without first clarifying risks immediate drug
accumulation/toxicity.
C. Requesting an alternative without prescriber approval
bypasses scope and may delay therapy.
D. Arbitrarily reducing dose is unsafe and not standard practice
without prescriber/pharmacy collaboration.
Teaching point: Clarify dose/orders before giving medications to
patients with impaired elimination.
Citation: Tucker, R. G. (2026). Karch’s Focus on Nursing
Pharmacology (10th ed.). Ch. 1.
2) Reference
Ch. 1 — Introduction to Drugs
,Stem: A nurse prepares to give a PRN opioid to a postoperative
patient complaining of severe pain. The patient’s pulse oximetry
reads 89% on room air and respiratory rate is 8 breaths/min.
What should the nurse do first?
A. Offer additional nonpharmacologic pain measures and
withhold opioid until respiratory status improves.
B. Administer the opioid and titrate dose for comfort; monitor
oxygen saturation frequently.
C. Increase the oxygen flow and then give the opioid to ensure
adequate oxygenation.
D. Call the prescriber to request a benzodiazepine instead for
anxiety to reduce perceived pain.
Correct answer: A
Rationale — Correct (A): With evidence of hypoventilation and
hypoxia, Karch’s principles prioritize patient safety: withhold
respiratory-depressant opioids and first use
nonopioid/nonpharmacologic measures while addressing
oxygenation and notifying the provider. Treating respiratory
compromise takes precedence.
Rationale — Incorrect:
B. Giving an opioid risks worsening hypoventilation and hypoxia.
C. Increasing oxygen without addressing respiratory depression
and withholding opioid still leaves risk; oxygen alone doesn't
correct low ventilation.
D. Benzodiazepines also depress respiration and would worsen
the problem.
, Teaching point: Withhold respiratory-depressant drugs in
hypoventilating, hypoxic patients; prioritize airway/oxygenation.
Citation: Tucker, R. G. (2026). Karch’s Focus on Nursing
Pharmacology (10th ed.). Ch. 1.
3) Reference
Ch. 1 — Introduction to Drugs
Stem: A newly admitted patient lists several over-the-counter
herbal supplements. Which nursing action best addresses
potential drug–herbal interactions before administering
prescribed medications?
A. Document the supplements in the chart and proceed with
the medication schedule.
B. Instruct the patient to stop all supplements immediately
without discussing with the prescriber.
C. Ask for specifics (names, doses) and notify the
prescriber/pharmacy to evaluate interactions.
D. Tell the patient that herbs are natural and unlikely to interact
with prescription drugs.
Correct answer: C
Rationale — Correct (C): Karch highlights medication
reconciliation and identification of all substances (including
herbal) because many interact with prescription drugs.
Gathering specifics and involving prescriber/pharmacy enables
safe, evidence-based decisions.
