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's baseline home
medications include a daily maintenance dose of an
aminoglycoside antibiotic for a localized soft tissue infection.
,Question Which pharmacokinetic phase will be most
significantly altered by the patient's current renal status?
Options A. Absorption B. Distribution C. Metabolism D.
Excretion
Correct Answer D
Rationale Excretion is the removal of a drug from the body,
which primarily occurs through the kidneys. In a patient with an
acute kidney injury, the renal clearance of drugs excreted via
glomerular filtration is significantly reduced, leading to
potential drug accumulation and toxicity. Aminoglycosides are
almost exclusively eliminated unchanged by the kidneys,
making excretion the most heavily impacted phase.
Why the Other Options Are Incorrect A. Absorption relates to
the movement of a drug from its site of administration into the
bloodstream, which is not primarily dictated by renal function.
B. Distribution involves the transport of a drug via the
bloodstream to its site of action and is more heavily influenced
by blood flow, tissue affinity, and protein binding. C.
Metabolism (biotransformation) occurs primarily in the liver,
turning active drugs into water-soluble metabolites, and is not
the primary process altered by an acute kidney injury.
Learning Objective Describe how renal impairment alters the
pharmacokinetic phase of drug elimination.
,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 preparing to administer an enteric-
coated aspirin tablet to a patient with chronic osteoarthritis.
The patient states, "Swallowing these thick pills is hard for me.
Can you crush it and mix it with some applesauce?"
Question What is the most appropriate action by the nurse?
Options A. Crush the tablet carefully and mix it into a small
amount of applesauce as requested. B. Dissolve the enteric-
coated tablet in warm water prior to administration. C. Inform
the patient that enteric-coated tablets cannot be crushed
because they are designed to dissolve in the small intestine. D.
Contact the healthcare provider to request an immediate route
change to an intravenous formulation.
Correct Answer C
Rationale Enteric-coated tablets are formulated with a special
outer layer that resists gastric acid, allowing the medication to
pass through the stomach intact and dissolve in the more
, alkaline environment of the small intestine. Crushing or
breaking these tablets destroys this protective coating, leading
to premature drug release, potential gastric irritation, or
inactivation of the medication by stomach acid.
Why the Other Options Are Incorrect A. Crushing an enteric-
coated medication exposes the stomach lining to gastric
irritation and destroys the extended or protected delivery
mechanism. B. Dissolving the tablet in water alters the chemical
integrity of the enteric coating before it even enters the
digestive tract. C. Changing to an intravenous formulation is an
unnecessary and invasive escalation for an administrative
challenge that can be solved by alternative oral formulations or
patient education.
Learning Objective Explain the clinical rationale for avoiding the
alteration of enteric-coated oral medications.
Bloom's Taxonomy Apply
Difficulty Easy
NCLEX Client Needs Category Pharmacological and Parenteral
Therapies
NCJMM Clinical Judgment Skill Take Action
Question 3
Clinical Scenario An 82-year-old female patient is prescribed an
oral medication that is highly bound to plasma proteins. The
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's baseline home
medications include a daily maintenance dose of an
aminoglycoside antibiotic for a localized soft tissue infection.
,Question Which pharmacokinetic phase will be most
significantly altered by the patient's current renal status?
Options A. Absorption B. Distribution C. Metabolism D.
Excretion
Correct Answer D
Rationale Excretion is the removal of a drug from the body,
which primarily occurs through the kidneys. In a patient with an
acute kidney injury, the renal clearance of drugs excreted via
glomerular filtration is significantly reduced, leading to
potential drug accumulation and toxicity. Aminoglycosides are
almost exclusively eliminated unchanged by the kidneys,
making excretion the most heavily impacted phase.
Why the Other Options Are Incorrect A. Absorption relates to
the movement of a drug from its site of administration into the
bloodstream, which is not primarily dictated by renal function.
B. Distribution involves the transport of a drug via the
bloodstream to its site of action and is more heavily influenced
by blood flow, tissue affinity, and protein binding. C.
Metabolism (biotransformation) occurs primarily in the liver,
turning active drugs into water-soluble metabolites, and is not
the primary process altered by an acute kidney injury.
Learning Objective Describe how renal impairment alters the
pharmacokinetic phase of drug elimination.
,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 preparing to administer an enteric-
coated aspirin tablet to a patient with chronic osteoarthritis.
The patient states, "Swallowing these thick pills is hard for me.
Can you crush it and mix it with some applesauce?"
Question What is the most appropriate action by the nurse?
Options A. Crush the tablet carefully and mix it into a small
amount of applesauce as requested. B. Dissolve the enteric-
coated tablet in warm water prior to administration. C. Inform
the patient that enteric-coated tablets cannot be crushed
because they are designed to dissolve in the small intestine. D.
Contact the healthcare provider to request an immediate route
change to an intravenous formulation.
Correct Answer C
Rationale Enteric-coated tablets are formulated with a special
outer layer that resists gastric acid, allowing the medication to
pass through the stomach intact and dissolve in the more
, alkaline environment of the small intestine. Crushing or
breaking these tablets destroys this protective coating, leading
to premature drug release, potential gastric irritation, or
inactivation of the medication by stomach acid.
Why the Other Options Are Incorrect A. Crushing an enteric-
coated medication exposes the stomach lining to gastric
irritation and destroys the extended or protected delivery
mechanism. B. Dissolving the tablet in water alters the chemical
integrity of the enteric coating before it even enters the
digestive tract. C. Changing to an intravenous formulation is an
unnecessary and invasive escalation for an administrative
challenge that can be solved by alternative oral formulations or
patient education.
Learning Objective Explain the clinical rationale for avoiding the
alteration of enteric-coated oral medications.
Bloom's Taxonomy Apply
Difficulty Easy
NCLEX Client Needs Category Pharmacological and Parenteral
Therapies
NCJMM Clinical Judgment Skill Take Action
Question 3
Clinical Scenario An 82-year-old female patient is prescribed an
oral medication that is highly bound to plasma proteins. The
