Karch’s Focus on Nursing Pharmacology 9th Edition
Test Bank by Rebecca Tucker | 1,135 MCQs +
Rationales | Chapters 1–60 | Updated 2026–2027
SECTION I: Introduction to Nursing Pharmacology (Questions 1–20)
Question 1
A nurse is reviewing a medication order for a patient with newly diagnosed
bacterial pneumonia. The patient has low serum albumin (2.4 g/dL). Which
nursing action is most appropriate before administering the first dose of a highly
protein-bound antibiotic?
A. Administer the dose and reassess in 48 hours
B. Check the patient's current medication list for other highly protein-bound drugs
C. Give the drug with a full meal to improve absorption
D. Hold the dose until albumin levels normalize
Correct Answer: B
Rationale: Low serum albumin means fewer protein-binding sites, leading
to more free (active) drug and increased risk of toxicity. Checking for other highly
protein-bound drugs helps identify additive displacement interactions. The dose
should not be held indefinitely; the provider may need notification, but the
immediate nursing action is to assess for interaction risk.
Question 2
A nurse working in radiology administers iodine for a CT scan. A nurse on the
oncology unit administers chemotherapy. A public health nurse administers an
MMR vaccine. Which branch of pharmacology best describes the actions of all
three nurses?
A. Pharmacoeconomics
B. Pharmacotherapeutics
,C. Pharmacodynamics
D. Pharmacokinetics
Correct Answer: B
Rationale: Pharmacotherapeutics deals with the uses of drugs to treat,
prevent, and diagnose disease. All three nurses are using drugs for therapeutic,
diagnostic, or preventive purposes. Pharmacoeconomics concerns cost;
pharmacodynamics is how drugs affect the body; pharmacokinetics is how the
body acts on drugs.
Question 3
A physician orders IM morphine every 4 hours PRN for a patient with severe pain.
The nurse recognizes morphine is classified under which controlled substance
schedule?
A. Schedule I
B. Schedule II
C. Schedule III
D. Schedule IV
Correct Answer: B
Rationale: Morphine is a Schedule II drug with high abuse potential and
severe dependence liability but accepted medical use. Schedule I drugs have no
accepted medical use. Schedule III and IV drugs have lesser abuse potential.
Question 4
A nurse is involved in a phase III drug evaluation study. What is the nurse's
primary responsibility?
A. Working with animals given experimental drugs
B. Choosing appropriate patients for the study
,C. Monitoring and observing patients closely for adverse effects
D. Conducting independent research to determine drug effectiveness
Correct Answer: C
Rationale: Phase III studies involve the drug in a vast clinical population.
Nurses monitor patients for adverse effects and help collect data. Animal testing
is preclinical. Patient selection is typically done by researchers. Nurses do not
prescribe or conduct independent research.
Question 5
When generic drugs are substituted for brand-name drugs, which concept is most
important to consider?
A. Bioavailability
B. Critical concentration
C. Distribution
D. Half-life
Correct Answer: A
Rationale: Bioavailability is the portion of a drug dose that reaches
systemic circulation. Binders in generic drugs may differ, altering bioavailability.
Critical concentration, distribution, and half-life should not differ significantly
between generic and brand-name drugs.
Question 6
A patient is started on a new antihypertensive. The nurse documents the time of
the first dose and plans to measure blood pressure at specified intervals. Which
pharmacokinetic parameter is the nurse most concerned with?
A. Bioavailability
B. Half-life
C. Onset of action
D. Peak plasma concentration
, Correct Answer: C
Rationale: Onset of action determines when a drug begins to produce
therapeutic or adverse effects. Monitoring around the expected onset helps
detect hypotension early. Bioavailability affects amount, half-life affects dosing
intervals, and peak concentration may occur after onset.
Question 7
A nurse reviews a patient's medication list and notes two drugs metabolized by
the same hepatic enzyme. The patient reports new fatigue and lightheadedness.
What is the most appropriate nursing interpretation?
A. The combination will increase renal excretion of both drugs
B. Co-administration may cause a drug-drug interaction altering drug levels
C. The drugs will neutralize each other and cause therapeutic failure
D. There is no concern because hepatic metabolism prevents interactions
Correct Answer: B
Rationale: Drugs metabolized by the same hepatic enzyme can compete
for the enzyme, leading to altered drug levels and increased toxicity or reduced
efficacy. This is a classic drug-drug interaction.
Question 8
A patient with a history of peptic ulcer disease is prescribed a new NSAID. Which
nursing action is most important?
A. Administer the NSAID on an empty stomach
B. Question the order because NSAIDs can worsen peptic ulcers
C. Give the NSAID with an antacid to prevent irritation
D. Monitor for constipation as the primary adverse effect
Correct Answer: B
Test Bank by Rebecca Tucker | 1,135 MCQs +
Rationales | Chapters 1–60 | Updated 2026–2027
SECTION I: Introduction to Nursing Pharmacology (Questions 1–20)
Question 1
A nurse is reviewing a medication order for a patient with newly diagnosed
bacterial pneumonia. The patient has low serum albumin (2.4 g/dL). Which
nursing action is most appropriate before administering the first dose of a highly
protein-bound antibiotic?
A. Administer the dose and reassess in 48 hours
B. Check the patient's current medication list for other highly protein-bound drugs
C. Give the drug with a full meal to improve absorption
D. Hold the dose until albumin levels normalize
Correct Answer: B
Rationale: Low serum albumin means fewer protein-binding sites, leading
to more free (active) drug and increased risk of toxicity. Checking for other highly
protein-bound drugs helps identify additive displacement interactions. The dose
should not be held indefinitely; the provider may need notification, but the
immediate nursing action is to assess for interaction risk.
Question 2
A nurse working in radiology administers iodine for a CT scan. A nurse on the
oncology unit administers chemotherapy. A public health nurse administers an
MMR vaccine. Which branch of pharmacology best describes the actions of all
three nurses?
A. Pharmacoeconomics
B. Pharmacotherapeutics
,C. Pharmacodynamics
D. Pharmacokinetics
Correct Answer: B
Rationale: Pharmacotherapeutics deals with the uses of drugs to treat,
prevent, and diagnose disease. All three nurses are using drugs for therapeutic,
diagnostic, or preventive purposes. Pharmacoeconomics concerns cost;
pharmacodynamics is how drugs affect the body; pharmacokinetics is how the
body acts on drugs.
Question 3
A physician orders IM morphine every 4 hours PRN for a patient with severe pain.
The nurse recognizes morphine is classified under which controlled substance
schedule?
A. Schedule I
B. Schedule II
C. Schedule III
D. Schedule IV
Correct Answer: B
Rationale: Morphine is a Schedule II drug with high abuse potential and
severe dependence liability but accepted medical use. Schedule I drugs have no
accepted medical use. Schedule III and IV drugs have lesser abuse potential.
Question 4
A nurse is involved in a phase III drug evaluation study. What is the nurse's
primary responsibility?
A. Working with animals given experimental drugs
B. Choosing appropriate patients for the study
,C. Monitoring and observing patients closely for adverse effects
D. Conducting independent research to determine drug effectiveness
Correct Answer: C
Rationale: Phase III studies involve the drug in a vast clinical population.
Nurses monitor patients for adverse effects and help collect data. Animal testing
is preclinical. Patient selection is typically done by researchers. Nurses do not
prescribe or conduct independent research.
Question 5
When generic drugs are substituted for brand-name drugs, which concept is most
important to consider?
A. Bioavailability
B. Critical concentration
C. Distribution
D. Half-life
Correct Answer: A
Rationale: Bioavailability is the portion of a drug dose that reaches
systemic circulation. Binders in generic drugs may differ, altering bioavailability.
Critical concentration, distribution, and half-life should not differ significantly
between generic and brand-name drugs.
Question 6
A patient is started on a new antihypertensive. The nurse documents the time of
the first dose and plans to measure blood pressure at specified intervals. Which
pharmacokinetic parameter is the nurse most concerned with?
A. Bioavailability
B. Half-life
C. Onset of action
D. Peak plasma concentration
, Correct Answer: C
Rationale: Onset of action determines when a drug begins to produce
therapeutic or adverse effects. Monitoring around the expected onset helps
detect hypotension early. Bioavailability affects amount, half-life affects dosing
intervals, and peak concentration may occur after onset.
Question 7
A nurse reviews a patient's medication list and notes two drugs metabolized by
the same hepatic enzyme. The patient reports new fatigue and lightheadedness.
What is the most appropriate nursing interpretation?
A. The combination will increase renal excretion of both drugs
B. Co-administration may cause a drug-drug interaction altering drug levels
C. The drugs will neutralize each other and cause therapeutic failure
D. There is no concern because hepatic metabolism prevents interactions
Correct Answer: B
Rationale: Drugs metabolized by the same hepatic enzyme can compete
for the enzyme, leading to altered drug levels and increased toxicity or reduced
efficacy. This is a classic drug-drug interaction.
Question 8
A patient with a history of peptic ulcer disease is prescribed a new NSAID. Which
nursing action is most important?
A. Administer the NSAID on an empty stomach
B. Question the order because NSAIDs can worsen peptic ulcers
C. Give the NSAID with an antacid to prevent irritation
D. Monitor for constipation as the primary adverse effect
Correct Answer: B
