Clayton’s Basic Pharmacology for Nurses, 20th Edition – Test
Bank with Questions and Answers
Unit 1: Foundations of Pharmacology
Chapter 1: Drug Definitions, Standards, and Information Sources
1. A nursing student is studying the Federal Food, Drug, and Cosmetic Act of 1938.
What was the primary significance of this legislation?
a) It classified drugs into five schedules based on abuse potential.
b) It required manufacturers to provide evidence of drug safety before marketing.
c) It mandated that all drugs be tested for effectiveness.
d) It established the Good Manufacturing Practices (GMP) requirements.
Answer: b) It required manufacturers to provide evidence of drug safety before
marketing.
Rationale: The 1938 Act was passed in response to the Elixir Sulfanilamide tragedy and
required proof of safety before marketing. The Durham-Humphrey Amendment (1951)
distinguished prescription from OTC drugs. The Kefauver-Harris Amendment (1962)
added effectiveness requirements.
2. A nurse is reviewing drug information and needs to know the legal standard for
drug strength, quality, and purity. Which resource should the nurse consult?
a) The Physician’s Desk Reference (PDR)
b) The United States Pharmacopeia/National Formulary (USP-NF)
c) The FDA Orange Book
d) The hospital formulary
Answer: b) The United States Pharmacopeia/National Formulary (USP-NF)
Rationale: USP-NF sets official standards for drug strength, quality, purity, packaging,
and labeling. Drugs that meet these standards carry the USP designation.
,3. A nurse is reviewing the Controlled Substances Act. Which schedule of
controlled substances has the highest potential for abuse and no accepted medical
use?
a) Schedule I
b) Schedule II
c) Schedule III
d) Schedule IV
Answer: a) Schedule I
Rationale: Schedule I drugs (e.g., heroin, LSD, marijuana at the federal level) have high
abuse potential, no currently accepted medical use in the US, and lack accepted safety
for use under medical supervision.
4. A patient asks the nurse, “What does it mean when the package says this drug is
‘off-label’ used?” What is the best response by the nurse?
a) “It means the drug is not approved by the FDA for any condition.”
b) “It means the drug is being used for a condition not officially approved by the FDA.”
c) “It means the drug has expired and should not be used.”
d) “It means the drug is only available over the counter.”
Answer: b) “It means the drug is being used for a condition not officially approved by
the FDA.”
Rationale: Off-label use refers to prescribing a drug for an indication, age group,
dosage, or route not included in the FDA-approved labeling. It is legal and common in
practice but requires informed consent.
Chapter 2: Pharmacokinetics and Pharmacodynamics
5. A nurse administers a drug that is known to be highly protein-bound. Which
statement best describes the implication of this property?
a) The drug will be rapidly excreted by the kidneys.
b) Only the free (unbound) fraction is pharmacologically active.
,c) The drug will have a very short duration of action.
d) The drug will be metabolized more quickly by the liver.
Answer: b) Only the free (unbound) fraction is pharmacologically active.
Rationale: Protein-bound drugs are inactive. Only the unbound fraction can cross
membranes to reach target receptors. High protein binding also means that
displacement by another drug can increase free drug levels and risk of toxicity.
6. A patient with liver failure is prescribed a medication that undergoes extensive
first-pass metabolism. What adjustment does the nurse anticipate?
a) A higher oral dose will be needed.
b) The drug may need to be administered via a parenteral route.
c) The drug will be excreted more rapidly.
d) The drug’s half-life will be shortened.
Answer: b) The drug may need to be administered via a parenteral route.
Rationale: First-pass metabolism occurs in the liver. In liver failure, oral drugs that
normally undergo extensive first-pass metabolism may reach much higher systemic
levels. To avoid toxicity, the drug may be given IV, IM, or sublingually to bypass the liver.
7. A nurse is explaining the concept of half-life to a patient. The patient asks,
“How long will it take for this drug to be mostly out of my system?” The drug has
a half-life of 8 hours. What is the best response?
a) “About 8 hours.”
b) “About 16 hours.”
c) “About 24 to 40 hours.”
d) “About 72 hours.”
Answer: c) “About 24 to 40 hours.”
Rationale: It takes approximately 3 to 5 half-lives for a drug to be eliminated from the
body. With an 8-hour half-life, elimination takes 24 to 40 hours.
, 8. A drug agonist works by:
a) Blocking receptor sites to prevent a response.
b) Binding to receptors and activating a response.
c) Altering the pH of body fluids to enhance absorption.
d) Increasing the excretion of other drugs.
Answer: b) Binding to receptors and activating a response.
Rationale: Agonists bind to receptors and mimic the action of endogenous substances,
producing a response. Antagonists block receptors.
Chapter 3: Drug Administration
9. A nurse is administering medications to a patient with a nasogastric (NG) tube
that is connected to continuous suction. What is the correct action before
administering an oral medication?
a) Administer the medication through the NG tube without interruption.
b) Clamp the NG tube for 30 to 60 minutes after administration.
c) Flush the NG tube with 5 mL of water before and after administration.
d) Crush all medications, including enteric-coated tablets, before administration.
Answer: b) Clamp the NG tube for 30 to 60 minutes after administration.
Rationale: If the NG tube is on continuous suction, clamping allows the medication to
be absorbed before being suctioned out. Enteric-coated or sustained-release tablets
should not be crushed.
10. A nurse is administering an intradermal injection. Which angle of insertion is
correct?
a) 5 to 15 degrees
b) 45 degrees
c) 90 degrees
d) 25 degrees
Answer: a) 5 to 15 degrees
Rationale: Intradermal injections are given at a 5- to 15-degree angle just under the
Bank with Questions and Answers
Unit 1: Foundations of Pharmacology
Chapter 1: Drug Definitions, Standards, and Information Sources
1. A nursing student is studying the Federal Food, Drug, and Cosmetic Act of 1938.
What was the primary significance of this legislation?
a) It classified drugs into five schedules based on abuse potential.
b) It required manufacturers to provide evidence of drug safety before marketing.
c) It mandated that all drugs be tested for effectiveness.
d) It established the Good Manufacturing Practices (GMP) requirements.
Answer: b) It required manufacturers to provide evidence of drug safety before
marketing.
Rationale: The 1938 Act was passed in response to the Elixir Sulfanilamide tragedy and
required proof of safety before marketing. The Durham-Humphrey Amendment (1951)
distinguished prescription from OTC drugs. The Kefauver-Harris Amendment (1962)
added effectiveness requirements.
2. A nurse is reviewing drug information and needs to know the legal standard for
drug strength, quality, and purity. Which resource should the nurse consult?
a) The Physician’s Desk Reference (PDR)
b) The United States Pharmacopeia/National Formulary (USP-NF)
c) The FDA Orange Book
d) The hospital formulary
Answer: b) The United States Pharmacopeia/National Formulary (USP-NF)
Rationale: USP-NF sets official standards for drug strength, quality, purity, packaging,
and labeling. Drugs that meet these standards carry the USP designation.
,3. A nurse is reviewing the Controlled Substances Act. Which schedule of
controlled substances has the highest potential for abuse and no accepted medical
use?
a) Schedule I
b) Schedule II
c) Schedule III
d) Schedule IV
Answer: a) Schedule I
Rationale: Schedule I drugs (e.g., heroin, LSD, marijuana at the federal level) have high
abuse potential, no currently accepted medical use in the US, and lack accepted safety
for use under medical supervision.
4. A patient asks the nurse, “What does it mean when the package says this drug is
‘off-label’ used?” What is the best response by the nurse?
a) “It means the drug is not approved by the FDA for any condition.”
b) “It means the drug is being used for a condition not officially approved by the FDA.”
c) “It means the drug has expired and should not be used.”
d) “It means the drug is only available over the counter.”
Answer: b) “It means the drug is being used for a condition not officially approved by
the FDA.”
Rationale: Off-label use refers to prescribing a drug for an indication, age group,
dosage, or route not included in the FDA-approved labeling. It is legal and common in
practice but requires informed consent.
Chapter 2: Pharmacokinetics and Pharmacodynamics
5. A nurse administers a drug that is known to be highly protein-bound. Which
statement best describes the implication of this property?
a) The drug will be rapidly excreted by the kidneys.
b) Only the free (unbound) fraction is pharmacologically active.
,c) The drug will have a very short duration of action.
d) The drug will be metabolized more quickly by the liver.
Answer: b) Only the free (unbound) fraction is pharmacologically active.
Rationale: Protein-bound drugs are inactive. Only the unbound fraction can cross
membranes to reach target receptors. High protein binding also means that
displacement by another drug can increase free drug levels and risk of toxicity.
6. A patient with liver failure is prescribed a medication that undergoes extensive
first-pass metabolism. What adjustment does the nurse anticipate?
a) A higher oral dose will be needed.
b) The drug may need to be administered via a parenteral route.
c) The drug will be excreted more rapidly.
d) The drug’s half-life will be shortened.
Answer: b) The drug may need to be administered via a parenteral route.
Rationale: First-pass metabolism occurs in the liver. In liver failure, oral drugs that
normally undergo extensive first-pass metabolism may reach much higher systemic
levels. To avoid toxicity, the drug may be given IV, IM, or sublingually to bypass the liver.
7. A nurse is explaining the concept of half-life to a patient. The patient asks,
“How long will it take for this drug to be mostly out of my system?” The drug has
a half-life of 8 hours. What is the best response?
a) “About 8 hours.”
b) “About 16 hours.”
c) “About 24 to 40 hours.”
d) “About 72 hours.”
Answer: c) “About 24 to 40 hours.”
Rationale: It takes approximately 3 to 5 half-lives for a drug to be eliminated from the
body. With an 8-hour half-life, elimination takes 24 to 40 hours.
, 8. A drug agonist works by:
a) Blocking receptor sites to prevent a response.
b) Binding to receptors and activating a response.
c) Altering the pH of body fluids to enhance absorption.
d) Increasing the excretion of other drugs.
Answer: b) Binding to receptors and activating a response.
Rationale: Agonists bind to receptors and mimic the action of endogenous substances,
producing a response. Antagonists block receptors.
Chapter 3: Drug Administration
9. A nurse is administering medications to a patient with a nasogastric (NG) tube
that is connected to continuous suction. What is the correct action before
administering an oral medication?
a) Administer the medication through the NG tube without interruption.
b) Clamp the NG tube for 30 to 60 minutes after administration.
c) Flush the NG tube with 5 mL of water before and after administration.
d) Crush all medications, including enteric-coated tablets, before administration.
Answer: b) Clamp the NG tube for 30 to 60 minutes after administration.
Rationale: If the NG tube is on continuous suction, clamping allows the medication to
be absorbed before being suctioned out. Enteric-coated or sustained-release tablets
should not be crushed.
10. A nurse is administering an intradermal injection. Which angle of insertion is
correct?
a) 5 to 15 degrees
b) 45 degrees
c) 90 degrees
d) 25 degrees
Answer: a) 5 to 15 degrees
Rationale: Intradermal injections are given at a 5- to 15-degree angle just under the
