Karch’s Focus on Nursing
Pharmacology
9th Edition
Author(s)Rebecca G. Tucker
TEST BANK
Question 1
Clinical Scenario A 42-year-old male is admitted to the medical-
surgical unit with an acute kidney injury secondary to severe
dehydration. The nurse notes that the patient is currently
prescribed lithium carbonate for bipolar disorder.
Question Which physiological process will most significantly
increase this patient's risk for lithium toxicity?
,Options A. Decreased glomerular filtration rate causing reduced
drug excretion B. Increased hepatic metabolism of lithium due
to compensatory mechanisms C. Enhanced gastrointestinal
absorption of lithium caused by dehydration D. Decreased
protein binding of lithium in the bloodstream
Correct Answer A. Decreased glomerular filtration rate causing
reduced drug excretion
Rationale Lithium is excreted entirely unchanged by the
kidneys. In the presence of an acute kidney injury and a
decreased glomerular filtration rate (GFR), the body's ability to
clear lithium is severely impaired. This leads to drug
accumulation in the bloodstream, rapidly escalating to toxic
levels. Additionally, in a dehydrated state, the proximal tubules
reabsorb more sodium and lithium together, further increasing
serum lithium levels.
Why the Other Options Are Incorrect A. This is the correct
statement. B. Lithium is not metabolized by the liver; it is
excreted entirely unchanged by the kidneys. C. Dehydration
does not inherently alter or increase the structural rate of
gastrointestinal absorption of lithium. D. Lithium does not bind
to plasma proteins; it circulates completely free in the plasma.
Learning Objective Explain how impaired renal excretion
impacts the pharmacokinetics and toxicity risk of lithium
carbonate.
,Bloom's Taxonomy Understand
Difficulty Easy
NCLEX Client Needs Category Pharmacological and Parenteral
Therapies
NCJMM Clinical Judgment Skill Recognize Cues
Question 2
Clinical Scenario A nurse is caring for a 68-year-old female
patient with a history of chronic open-angle glaucoma who has
just been prescribed an oral first-generation antihistamine for
seasonal allergies.
Question Which pharmacological concept explains why this
medication is contraindicated for this patient?
Options A. The drug blocks cholinergic receptors, causing
pupillary dilation and increasing intraocular pressure. B. The
drug stimulates alpha-1 adrenergic receptors, causing
vasoconstriction in the ocular blood vessels. C. The drug inhibits
beta-2 receptors, leading to a decrease in aqueous humor
outflow. D. The drug accelerates the breakdown of
acetylcholine, leading to ciliary muscle paralysis.
Correct Answer A. The drug blocks cholinergic receptors,
causing pupillary dilation and increasing intraocular pressure.
, Rationale First-generation antihistamines possess significant
anticholinergic side effects. By blocking muscarinic/cholinergic
receptors, they cause mydriasis (pupillary dilation). In patients
with glaucoma, mydriasis can narrow the trabecular meshwork
angle, obstructing the drainage of aqueous humor and
dangerously elevating intraocular pressure.
Why the Other Options Are Incorrect A. This is the correct
statement. B. Antihistamines do not act as alpha-1 adrenergic
agonists. C. Antihistamines do not possess beta-blocking
properties. D. Antihistamines block acetylcholine receptors
rather than accelerating the enzymatic breakdown of
acetylcholine.
Learning Objective Identify contraindications of first-generation
antihistamines based on their anticholinergic profile.
Bloom's Taxonomy Understand
Difficulty Easy
NCLEX Client Needs Category Pharmacological and Parenteral
Therapies
NCJMM Clinical Judgment Skill Recognize Cues
Question 3
Clinical Scenario The nurse is preparing to administer an
intravenous bolus dose of a highly protein-bound medication to
Pharmacology
9th Edition
Author(s)Rebecca G. Tucker
TEST BANK
Question 1
Clinical Scenario A 42-year-old male is admitted to the medical-
surgical unit with an acute kidney injury secondary to severe
dehydration. The nurse notes that the patient is currently
prescribed lithium carbonate for bipolar disorder.
Question Which physiological process will most significantly
increase this patient's risk for lithium toxicity?
,Options A. Decreased glomerular filtration rate causing reduced
drug excretion B. Increased hepatic metabolism of lithium due
to compensatory mechanisms C. Enhanced gastrointestinal
absorption of lithium caused by dehydration D. Decreased
protein binding of lithium in the bloodstream
Correct Answer A. Decreased glomerular filtration rate causing
reduced drug excretion
Rationale Lithium is excreted entirely unchanged by the
kidneys. In the presence of an acute kidney injury and a
decreased glomerular filtration rate (GFR), the body's ability to
clear lithium is severely impaired. This leads to drug
accumulation in the bloodstream, rapidly escalating to toxic
levels. Additionally, in a dehydrated state, the proximal tubules
reabsorb more sodium and lithium together, further increasing
serum lithium levels.
Why the Other Options Are Incorrect A. This is the correct
statement. B. Lithium is not metabolized by the liver; it is
excreted entirely unchanged by the kidneys. C. Dehydration
does not inherently alter or increase the structural rate of
gastrointestinal absorption of lithium. D. Lithium does not bind
to plasma proteins; it circulates completely free in the plasma.
Learning Objective Explain how impaired renal excretion
impacts the pharmacokinetics and toxicity risk of lithium
carbonate.
,Bloom's Taxonomy Understand
Difficulty Easy
NCLEX Client Needs Category Pharmacological and Parenteral
Therapies
NCJMM Clinical Judgment Skill Recognize Cues
Question 2
Clinical Scenario A nurse is caring for a 68-year-old female
patient with a history of chronic open-angle glaucoma who has
just been prescribed an oral first-generation antihistamine for
seasonal allergies.
Question Which pharmacological concept explains why this
medication is contraindicated for this patient?
Options A. The drug blocks cholinergic receptors, causing
pupillary dilation and increasing intraocular pressure. B. The
drug stimulates alpha-1 adrenergic receptors, causing
vasoconstriction in the ocular blood vessels. C. The drug inhibits
beta-2 receptors, leading to a decrease in aqueous humor
outflow. D. The drug accelerates the breakdown of
acetylcholine, leading to ciliary muscle paralysis.
Correct Answer A. The drug blocks cholinergic receptors,
causing pupillary dilation and increasing intraocular pressure.
, Rationale First-generation antihistamines possess significant
anticholinergic side effects. By blocking muscarinic/cholinergic
receptors, they cause mydriasis (pupillary dilation). In patients
with glaucoma, mydriasis can narrow the trabecular meshwork
angle, obstructing the drainage of aqueous humor and
dangerously elevating intraocular pressure.
Why the Other Options Are Incorrect A. This is the correct
statement. B. Antihistamines do not act as alpha-1 adrenergic
agonists. C. Antihistamines do not possess beta-blocking
properties. D. Antihistamines block acetylcholine receptors
rather than accelerating the enzymatic breakdown of
acetylcholine.
Learning Objective Identify contraindications of first-generation
antihistamines based on their anticholinergic profile.
Bloom's Taxonomy Understand
Difficulty Easy
NCLEX Client Needs Category Pharmacological and Parenteral
Therapies
NCJMM Clinical Judgment Skill Recognize Cues
Question 3
Clinical Scenario The nurse is preparing to administer an
intravenous bolus dose of a highly protein-bound medication to
