Lehne's Pharmacology for Nursing
Care
12th Edition
• Author(s)Jacqueline Rosenjack
Burchum; Laura D. Rosenthal
,TEST BANK
Question 1
Type: MCQ
Clinical Scenario:
A 78-year-old patient with heart failure and decreased renal
function is prescribed a new medication that is primarily
excreted unchanged by the kidneys.
Question Stem:
Based on the patient's age and condition, the nurse should
anticipate which modification to the medication regimen?
Answer Options:
A. A higher loading dose to achieve therapeutic levels faster.
B. A reduced maintenance dose or extended dosing interval.
C. An increased maintenance dose to compensate for decreased
absorption.
D. No modification is needed; renal function does not affect
drug excretion.
Correct Answer: B
Detailed Rationale:
Geriatric patients and those with renal impairment typically
have decreased glomerular filtration. A drug excreted
,unchanged by the kidneys will accumulate, leading to toxicity.
The correct action is to reduce the maintenance dose or
lengthen the interval to prevent drug accumulation while still
achieving therapeutic goals. This is a key application of
pharmacokinetic principles in pharmacotherapeutics.
Incorrect Option Analysis:
• A. A higher loading dose: Incorrect. A higher loading dose
would increase the risk of toxicity from the outset,
especially since the drug cannot be cleared efficiently.
While loading doses may be used, they must be calculated
carefully in renal impairment.
• C. An increased maintenance dose: Incorrect. This would
directly lead to drug accumulation and severe toxicity. This
is a dangerous misconception.
• D. No modification is needed: Incorrect. This displays a
lack of understanding of the relationship between organ
function and drug excretion. Failing to adjust the dose is a
serious medication safety risk.
Nursing Process Linkage: Planning
Clinical Judgment Competencies (NCJMM): Analyze Cues,
Generate Solutions
Difficulty Level: Moderate
Bloom's Cognitive Level: Apply
NCLEX Client Needs Category: Pharmacological and Parenteral
, Therapies / Reduction of Risk Potential
Key Learning Objective: Apply principles of pharmacokinetics
(excretion) to modify drug therapy for a patient with renal
impairment.
Question 2
Type: MCQ
Clinical Scenario:
A nurse is preparing to administer a drug that has a narrow
therapeutic index to a patient.
Question Stem:
The nurse understands that a narrow therapeutic index means:
Answer Options:
A. The drug is effective against a very narrow range of
microorganisms.
B. The drug has a high margin of safety and is unlikely to cause
adverse effects.
C. There is a small margin between the minimum effective
concentration and the minimum toxic concentration of the
drug.
D. The drug will only be effective for a short period of time.
Correct Answer: C
Care
12th Edition
• Author(s)Jacqueline Rosenjack
Burchum; Laura D. Rosenthal
,TEST BANK
Question 1
Type: MCQ
Clinical Scenario:
A 78-year-old patient with heart failure and decreased renal
function is prescribed a new medication that is primarily
excreted unchanged by the kidneys.
Question Stem:
Based on the patient's age and condition, the nurse should
anticipate which modification to the medication regimen?
Answer Options:
A. A higher loading dose to achieve therapeutic levels faster.
B. A reduced maintenance dose or extended dosing interval.
C. An increased maintenance dose to compensate for decreased
absorption.
D. No modification is needed; renal function does not affect
drug excretion.
Correct Answer: B
Detailed Rationale:
Geriatric patients and those with renal impairment typically
have decreased glomerular filtration. A drug excreted
,unchanged by the kidneys will accumulate, leading to toxicity.
The correct action is to reduce the maintenance dose or
lengthen the interval to prevent drug accumulation while still
achieving therapeutic goals. This is a key application of
pharmacokinetic principles in pharmacotherapeutics.
Incorrect Option Analysis:
• A. A higher loading dose: Incorrect. A higher loading dose
would increase the risk of toxicity from the outset,
especially since the drug cannot be cleared efficiently.
While loading doses may be used, they must be calculated
carefully in renal impairment.
• C. An increased maintenance dose: Incorrect. This would
directly lead to drug accumulation and severe toxicity. This
is a dangerous misconception.
• D. No modification is needed: Incorrect. This displays a
lack of understanding of the relationship between organ
function and drug excretion. Failing to adjust the dose is a
serious medication safety risk.
Nursing Process Linkage: Planning
Clinical Judgment Competencies (NCJMM): Analyze Cues,
Generate Solutions
Difficulty Level: Moderate
Bloom's Cognitive Level: Apply
NCLEX Client Needs Category: Pharmacological and Parenteral
, Therapies / Reduction of Risk Potential
Key Learning Objective: Apply principles of pharmacokinetics
(excretion) to modify drug therapy for a patient with renal
impairment.
Question 2
Type: MCQ
Clinical Scenario:
A nurse is preparing to administer a drug that has a narrow
therapeutic index to a patient.
Question Stem:
The nurse understands that a narrow therapeutic index means:
Answer Options:
A. The drug is effective against a very narrow range of
microorganisms.
B. The drug has a high margin of safety and is unlikely to cause
adverse effects.
C. There is a small margin between the minimum effective
concentration and the minimum toxic concentration of the
drug.
D. The drug will only be effective for a short period of time.
Correct Answer: C
