KARCH’S FOCUS ON NURSING
PHARMACOLOGY
10TH EDITION
• AUTHOR(S)REBECCA G. TUCKER
TEST BANK
1) Ch. 1 — Introduction to Drugs
Stem: A 68-year-old man is admitted with community-acquired
pneumonia. His MAR lists a new order for oral ciprofloxacin 500
mg twice daily. He takes tamsulosin for BPH and reports current
constipation and a history of Achilles tendonitis. Which action
should the nurse perform first before administering the first
dose?
A. Hold the dose and ask the prescriber to change to another
antibiotic.
B. Ask the patient about a history of QT prolongation or tendon
problems and check recently prescribed meds.
,C. Administer the dose with a glass of milk to decrease GI upset.
D. Provide a laxative to relieve constipation before giving the
antibiotic.
Correct Answer: B
Rationale — Correct: Asking about QT prolongation and tendon
problems and checking current meds identifies risk factors and
interactions (fluoroquinolones can prolong QT and increase
tendon rupture risk). Karch emphasizes preadministration
assessment to detect contraindications and interactions before
giving a drug. This protects the patient and guides the
prescriber if the drug is unsafe.
Rationale — Incorrect:
A. Prematurely holding and requesting change without
assessment omits vital information and is not the first action.
C. Giving ciprofloxacin with milk reduces absorption and
bioavailability — inappropriate.
D. Providing a laxative before antibiotic addresses a symptom
but does not assess medication safety or interactions.
Teaching point: Assess for specific drug-related
contraindications and interactions before first dose.
Citation: Tucker, R. G. (2026). Karch’s Focus on Nursing
Pharmacology (10th ed.). Ch. 1.
2) Ch. 1 — Introduction to Drugs
,Stem: A patient receiving digoxin has a serum potassium of 3.2
mEq/L and complains of nausea and visual changes. The nurse
recalls digoxin has a narrow therapeutic index. What should the
nurse do first?
A. Administer ordered potassium chloride and document.
B. Hold the next dose of digoxin and notify the prescriber
immediately.
C. Obtain a repeat serum potassium in 24 hours.
D. Encourage the patient to eat high-potassium foods and
reassess in the morning.
Correct Answer: B
Rationale — Correct: With signs of digoxin toxicity and
hypokalemia (which potentiates toxicity), holding digoxin and
notifying the prescriber is highest priority to prevent harm.
Karch highlights that narrow therapeutic index drugs require
prompt nursing action when toxicity is suspected.
Rationale — Incorrect:
A. Giving potassium is appropriate but notifying prescriber and
holding digoxin should occur first because ongoing dosing
increases toxicity risk.
C. Waiting 24 hours delays critical intervention.
D. Dietary measures are insufficient for acute hypokalemia and
toxicity.
Teaching point: For narrow therapeutic drugs, hold doses and
notify prescriber if toxicity is suspected.
, Citation: Tucker, R. G. (2026). Karch’s Focus on Nursing
Pharmacology (10th ed.). Ch. 1.
3) Ch. 1 — Introduction to Drugs
Stem: A hospitalized patient is prescribed a medication that is
highly protein bound. The patient has chronic kidney disease
and low serum albumin (2.0 g/dL). Which interpretation should
guide the nurse’s monitoring plan?
A. Expect decreased free drug levels and less effect; routine
dosing is fine.
B. Expect increased free (active) drug levels with greater risk of
toxicity; monitor closely.
C. No change—protein binding does not affect drug activity.
D. Increase the dose to overcome low albumin binding.
Correct Answer: B
Rationale — Correct: Low albumin reduces protein binding,
increasing free (active) drug concentration and toxicity risk.
Karch teaches that altered protein binding in disease states
changes drug distribution and monitoring needs.
Rationale — Incorrect:
A. Free drug increases, not decreases.
C. Protein binding significantly affects pharmacologic activity—
incorrect.
D. Increasing dose would worsen toxicity given higher free
levels.
PHARMACOLOGY
10TH EDITION
• AUTHOR(S)REBECCA G. TUCKER
TEST BANK
1) Ch. 1 — Introduction to Drugs
Stem: A 68-year-old man is admitted with community-acquired
pneumonia. His MAR lists a new order for oral ciprofloxacin 500
mg twice daily. He takes tamsulosin for BPH and reports current
constipation and a history of Achilles tendonitis. Which action
should the nurse perform first before administering the first
dose?
A. Hold the dose and ask the prescriber to change to another
antibiotic.
B. Ask the patient about a history of QT prolongation or tendon
problems and check recently prescribed meds.
,C. Administer the dose with a glass of milk to decrease GI upset.
D. Provide a laxative to relieve constipation before giving the
antibiotic.
Correct Answer: B
Rationale — Correct: Asking about QT prolongation and tendon
problems and checking current meds identifies risk factors and
interactions (fluoroquinolones can prolong QT and increase
tendon rupture risk). Karch emphasizes preadministration
assessment to detect contraindications and interactions before
giving a drug. This protects the patient and guides the
prescriber if the drug is unsafe.
Rationale — Incorrect:
A. Prematurely holding and requesting change without
assessment omits vital information and is not the first action.
C. Giving ciprofloxacin with milk reduces absorption and
bioavailability — inappropriate.
D. Providing a laxative before antibiotic addresses a symptom
but does not assess medication safety or interactions.
Teaching point: Assess for specific drug-related
contraindications and interactions before first dose.
Citation: Tucker, R. G. (2026). Karch’s Focus on Nursing
Pharmacology (10th ed.). Ch. 1.
2) Ch. 1 — Introduction to Drugs
,Stem: A patient receiving digoxin has a serum potassium of 3.2
mEq/L and complains of nausea and visual changes. The nurse
recalls digoxin has a narrow therapeutic index. What should the
nurse do first?
A. Administer ordered potassium chloride and document.
B. Hold the next dose of digoxin and notify the prescriber
immediately.
C. Obtain a repeat serum potassium in 24 hours.
D. Encourage the patient to eat high-potassium foods and
reassess in the morning.
Correct Answer: B
Rationale — Correct: With signs of digoxin toxicity and
hypokalemia (which potentiates toxicity), holding digoxin and
notifying the prescriber is highest priority to prevent harm.
Karch highlights that narrow therapeutic index drugs require
prompt nursing action when toxicity is suspected.
Rationale — Incorrect:
A. Giving potassium is appropriate but notifying prescriber and
holding digoxin should occur first because ongoing dosing
increases toxicity risk.
C. Waiting 24 hours delays critical intervention.
D. Dietary measures are insufficient for acute hypokalemia and
toxicity.
Teaching point: For narrow therapeutic drugs, hold doses and
notify prescriber if toxicity is suspected.
, Citation: Tucker, R. G. (2026). Karch’s Focus on Nursing
Pharmacology (10th ed.). Ch. 1.
3) Ch. 1 — Introduction to Drugs
Stem: A hospitalized patient is prescribed a medication that is
highly protein bound. The patient has chronic kidney disease
and low serum albumin (2.0 g/dL). Which interpretation should
guide the nurse’s monitoring plan?
A. Expect decreased free drug levels and less effect; routine
dosing is fine.
B. Expect increased free (active) drug levels with greater risk of
toxicity; monitor closely.
C. No change—protein binding does not affect drug activity.
D. Increase the dose to overcome low albumin binding.
Correct Answer: B
Rationale — Correct: Low albumin reduces protein binding,
increasing free (active) drug concentration and toxicity risk.
Karch teaches that altered protein binding in disease states
changes drug distribution and monitoring needs.
Rationale — Incorrect:
A. Free drug increases, not decreases.
C. Protein binding significantly affects pharmacologic activity—
incorrect.
D. Increasing dose would worsen toxicity given higher free
levels.
