Abrams' Clinical Drug Therapy
Rationales for Nursing Practice
13th Edition
• Author(s)Geralyn Frandsen;
Sandra Pennington
TEST BANK
,Question 1
A patient receiving a continuous intravenous infusion of a
medication with a narrow therapeutic index has a serum drug
level drawn at 0800, which returns at 1000 with a value of 22
mcg/mL (therapeutic range: 10-20 mcg/mL). The nurse notes
that the patient is asymptomatic. What is the priority nursing
action?
A. Stop the infusion immediately and notify the healthcare
provider.
B. Decrease the infusion rate by half and recheck the level in 6
hours.
C. Continue the current infusion rate and assess the patient for
early signs of toxicity.
D. Hold the next scheduled dose and document the finding in
the chart.
Correct Answer: A
Rationale: A serum level above the therapeutic range indicates
potential toxicity, even in an asymptomatic patient. The priority
action is to stop the infusion to prevent further drug
accumulation and notify the healthcare provider for a new
dosing order. Decreasing the rate without an order or
continuing the infusion places the patient at risk for severe
adverse effects. Holding only the next dose does not address
the continuous nature of the infusion.
,Question 2
The nurse is caring for a patient prescribed a cholinergic agonist
for the management of a gastrointestinal motility disorder.
Which assessment finding would indicate a therapeutic
response to this medication?
A. Decreased heart rate from 88 to 62 beats per minute.
B. Increased bowel sounds in all four quadrants.
C. Pupillary dilation noted on a neurological exam.
D. Dry mouth and urinary retention.
Correct Answer: B
Rationale: Cholinergic agonists stimulate the parasympathetic
nervous system, increasing gastrointestinal motility and
secretions, which would manifest as increased bowel sounds. A
decreased heart rate is a potential adverse effect, not a
therapeutic response for a GI motility disorder. Pupillary dilation
and dry mouth are associated with anticholinergic effects, not
cholinergic stimulation.
Question 3
A patient is started on a new antihypertensive medication that
blocks beta-1 adrenergic receptors. The nurse should instruct
the patient to monitor for which specific adverse effect related
to this receptor selectivity?
A. Bronchospasm and wheezing.
B. Peripheral vasoconstriction and cold extremities.
C. Bradycardia and decreased exercise tolerance.
, D. Hyperglycemia and increased thirst.
Correct Answer: C
Rationale: Beta-1 selective blockade primarily affects the heart,
leading to decreased heart rate (bradycardia) and reduced
cardiac output, which can cause decreased exercise tolerance.
Bronchospasm is more associated with non-selective beta
blockade affecting beta-2 receptors. Peripheral vasoconstriction
is not a direct effect of beta-1 blockade. Hyperglycemia is not a
typical adverse effect of beta-blockers; they can actually mask
symptoms of hypoglycemia.
Question 4
A nurse is preparing to administer a loop diuretic to a patient
with heart failure. The patient’s morning laboratory results
show a serum potassium of 3.2 mEq/L and a serum sodium of
135 mEq/L. Which nursing action is most appropriate before
administering the medication?
A. Administer the diuretic as ordered and monitor for
orthostatic hypotension.
B. Hold the diuretic and notify the healthcare provider of the
potassium level.
C. Administer the diuretic with a potassium-sparing agent as a
standing order.
D. Give the diuretic and encourage the patient to drink orange
juice.
Correct Answer: B
Rationales for Nursing Practice
13th Edition
• Author(s)Geralyn Frandsen;
Sandra Pennington
TEST BANK
,Question 1
A patient receiving a continuous intravenous infusion of a
medication with a narrow therapeutic index has a serum drug
level drawn at 0800, which returns at 1000 with a value of 22
mcg/mL (therapeutic range: 10-20 mcg/mL). The nurse notes
that the patient is asymptomatic. What is the priority nursing
action?
A. Stop the infusion immediately and notify the healthcare
provider.
B. Decrease the infusion rate by half and recheck the level in 6
hours.
C. Continue the current infusion rate and assess the patient for
early signs of toxicity.
D. Hold the next scheduled dose and document the finding in
the chart.
Correct Answer: A
Rationale: A serum level above the therapeutic range indicates
potential toxicity, even in an asymptomatic patient. The priority
action is to stop the infusion to prevent further drug
accumulation and notify the healthcare provider for a new
dosing order. Decreasing the rate without an order or
continuing the infusion places the patient at risk for severe
adverse effects. Holding only the next dose does not address
the continuous nature of the infusion.
,Question 2
The nurse is caring for a patient prescribed a cholinergic agonist
for the management of a gastrointestinal motility disorder.
Which assessment finding would indicate a therapeutic
response to this medication?
A. Decreased heart rate from 88 to 62 beats per minute.
B. Increased bowel sounds in all four quadrants.
C. Pupillary dilation noted on a neurological exam.
D. Dry mouth and urinary retention.
Correct Answer: B
Rationale: Cholinergic agonists stimulate the parasympathetic
nervous system, increasing gastrointestinal motility and
secretions, which would manifest as increased bowel sounds. A
decreased heart rate is a potential adverse effect, not a
therapeutic response for a GI motility disorder. Pupillary dilation
and dry mouth are associated with anticholinergic effects, not
cholinergic stimulation.
Question 3
A patient is started on a new antihypertensive medication that
blocks beta-1 adrenergic receptors. The nurse should instruct
the patient to monitor for which specific adverse effect related
to this receptor selectivity?
A. Bronchospasm and wheezing.
B. Peripheral vasoconstriction and cold extremities.
C. Bradycardia and decreased exercise tolerance.
, D. Hyperglycemia and increased thirst.
Correct Answer: C
Rationale: Beta-1 selective blockade primarily affects the heart,
leading to decreased heart rate (bradycardia) and reduced
cardiac output, which can cause decreased exercise tolerance.
Bronchospasm is more associated with non-selective beta
blockade affecting beta-2 receptors. Peripheral vasoconstriction
is not a direct effect of beta-1 blockade. Hyperglycemia is not a
typical adverse effect of beta-blockers; they can actually mask
symptoms of hypoglycemia.
Question 4
A nurse is preparing to administer a loop diuretic to a patient
with heart failure. The patient’s morning laboratory results
show a serum potassium of 3.2 mEq/L and a serum sodium of
135 mEq/L. Which nursing action is most appropriate before
administering the medication?
A. Administer the diuretic as ordered and monitor for
orthostatic hypotension.
B. Hold the diuretic and notify the healthcare provider of the
potassium level.
C. Administer the diuretic with a potassium-sparing agent as a
standing order.
D. Give the diuretic and encourage the patient to drink orange
juice.
Correct Answer: B
