Karch’s Focus on Nursing
Pharmacology
9th Edition
Author(s)Rebecca G. Tucker
TEST BANK
Question 1
Clinical Scenario A nurse is reviewing the medication
administration record for an older adult patient who is
prescribed a highly protein-bound medication. The patient’s
recent laboratory results indicate a serum albumin level of 2.2
g/dL (normal: 3.5–5.0 g/dL).
,Question Based on this laboratory finding, the nurse should
anticipate which pharmacokinetic change?
Options A. Decreased metabolic rate of the drug by the liver. B.
Increased concentration of free, active drug in the circulation. C.
Decreased absorption of the drug from the gastrointestinal
tract. D. Accelerated renal excretion of the drug.
Correct Answer B
Rationale Albumin is the primary plasma protein that binds to
drugs in the bloodstream. When a drug is bound to protein, it
remains inactive. Only the unbound ("free") drug can exert a
therapeutic effect. A serum albumin level of 2.2 g/dL indicates
severe hypoalbuminemia. With fewer protein-binding sites
available, a greater percentage of the highly protein-bound drug
remains free and active, significantly increasing the risk of drug
toxicity.
Why the Other Options Are Incorrect A. Liver metabolism is
governed by hepatic enzyme activity and blood flow, not
directly by serum albumin levels. C. Drug absorption occurs
before the drug enters systemic circulation to bind with plasma
proteins; therefore, hypoalbuminemia does not decrease
gastrointestinal absorption. D. While free drug is available for
filtration, the immediate and primary concern is the elevated
level of active drug in the tissues, which increases
,pharmacological effects rather than instantly accelerating
clearance to a safe equilibrium.
Learning Objective Explain the effect of serum plasma protein
levels on the distribution and toxicity risk of highly protein-
bound medications.
Bloom's Taxonomy Understand
Difficulty Easy
NCLEX Client Needs Category Physiological Integrity:
Pharmacological and Parenteral Therapies
NCJMM Clinical Judgment Skill Recognize Cues
Question 2
Clinical Scenario A nurse is caring for a patient who has been
taking an oral antibiotic for a severe skin infection. The patient
reports experiencing frequent, watery stools and abdominal
cramping over the past 24 hours.
Question The nurse recognizes that these symptoms most likely
represent which type of drug effect?
Options A. An expected primary therapeutic action. B. A
secondary action known as a superinfection. C. An immediate
Type I hypersensitivity reaction. D. An idiosyncratic drug
response.
Correct Answer B
, Rationale Antibiotics can destroy the normal flora of the
gastrointestinal tract, disrupting the microbial balance. This
allows opportunistic pathogens, such as Clostridioides difficile,
to overgrow, resulting in a superinfection characterized by
diarrhea and cramping. This is a known secondary adverse
effect of broad-spectrum antibiotic therapy.
Why the Other Options Are Incorrect A. Destruction of normal
GI flora and subsequent diarrhea is an adverse effect, not the
primary therapeutic goal of treating a skin infection. C. Type I
hypersensitivity reactions are mediated by IgE and typically
present with urticaria, pruritus, bronchospasm, or anaphylaxis,
not isolated delayed GI distress. D. An idiosyncratic reaction is
an unpredicted, genetically determined, or unusual response to
a drug completely unrelated to its known pharmacological
actions, whereas antibiotic-associated diarrhea is a well-
understood complication.
Learning Objective Identify signs and symptoms of a
superinfection as a secondary adverse effect of antibiotic
therapy.
Bloom's Taxonomy Understand
Difficulty Easy
NCLEX Client Needs Category Physiological Integrity:
Pharmacological and Parenteral Therapies
Pharmacology
9th Edition
Author(s)Rebecca G. Tucker
TEST BANK
Question 1
Clinical Scenario A nurse is reviewing the medication
administration record for an older adult patient who is
prescribed a highly protein-bound medication. The patient’s
recent laboratory results indicate a serum albumin level of 2.2
g/dL (normal: 3.5–5.0 g/dL).
,Question Based on this laboratory finding, the nurse should
anticipate which pharmacokinetic change?
Options A. Decreased metabolic rate of the drug by the liver. B.
Increased concentration of free, active drug in the circulation. C.
Decreased absorption of the drug from the gastrointestinal
tract. D. Accelerated renal excretion of the drug.
Correct Answer B
Rationale Albumin is the primary plasma protein that binds to
drugs in the bloodstream. When a drug is bound to protein, it
remains inactive. Only the unbound ("free") drug can exert a
therapeutic effect. A serum albumin level of 2.2 g/dL indicates
severe hypoalbuminemia. With fewer protein-binding sites
available, a greater percentage of the highly protein-bound drug
remains free and active, significantly increasing the risk of drug
toxicity.
Why the Other Options Are Incorrect A. Liver metabolism is
governed by hepatic enzyme activity and blood flow, not
directly by serum albumin levels. C. Drug absorption occurs
before the drug enters systemic circulation to bind with plasma
proteins; therefore, hypoalbuminemia does not decrease
gastrointestinal absorption. D. While free drug is available for
filtration, the immediate and primary concern is the elevated
level of active drug in the tissues, which increases
,pharmacological effects rather than instantly accelerating
clearance to a safe equilibrium.
Learning Objective Explain the effect of serum plasma protein
levels on the distribution and toxicity risk of highly protein-
bound medications.
Bloom's Taxonomy Understand
Difficulty Easy
NCLEX Client Needs Category Physiological Integrity:
Pharmacological and Parenteral Therapies
NCJMM Clinical Judgment Skill Recognize Cues
Question 2
Clinical Scenario A nurse is caring for a patient who has been
taking an oral antibiotic for a severe skin infection. The patient
reports experiencing frequent, watery stools and abdominal
cramping over the past 24 hours.
Question The nurse recognizes that these symptoms most likely
represent which type of drug effect?
Options A. An expected primary therapeutic action. B. A
secondary action known as a superinfection. C. An immediate
Type I hypersensitivity reaction. D. An idiosyncratic drug
response.
Correct Answer B
, Rationale Antibiotics can destroy the normal flora of the
gastrointestinal tract, disrupting the microbial balance. This
allows opportunistic pathogens, such as Clostridioides difficile,
to overgrow, resulting in a superinfection characterized by
diarrhea and cramping. This is a known secondary adverse
effect of broad-spectrum antibiotic therapy.
Why the Other Options Are Incorrect A. Destruction of normal
GI flora and subsequent diarrhea is an adverse effect, not the
primary therapeutic goal of treating a skin infection. C. Type I
hypersensitivity reactions are mediated by IgE and typically
present with urticaria, pruritus, bronchospasm, or anaphylaxis,
not isolated delayed GI distress. D. An idiosyncratic reaction is
an unpredicted, genetically determined, or unusual response to
a drug completely unrelated to its known pharmacological
actions, whereas antibiotic-associated diarrhea is a well-
understood complication.
Learning Objective Identify signs and symptoms of a
superinfection as a secondary adverse effect of antibiotic
therapy.
Bloom's Taxonomy Understand
Difficulty Easy
NCLEX Client Needs Category Physiological Integrity:
Pharmacological and Parenteral Therapies
