KARCH’S FOCUS ON NURSING
PHARMACOLOGY
10TH EDITION
• AUTHOR(S)REBECCA G. TUCKER
TEST BANK
1)
Reference: Ch. 1 — Introduction to Drugs
Stem: A 72-year-old client with chronic heart failure (ejection
fraction 30%) is prescribed a new oral medication that is highly
protein-bound. The nurse notes the client has low serum
albumin (2.5 g/dL). Which nursing action is most appropriate
before administering the first dose?
A. Give the dose and monitor blood pressure hourly.
B. Hold the dose and contact the prescriber to discuss a lower
dose.
,C. Administer the dose with a light snack to improve absorption.
D. Split the tablet and give half now and half in 12 hours.
Correct Answer: B
Rationale — Correct (B): Low albumin increases the free
fraction of highly protein-bound drugs, raising risk of toxicity.
Holding and contacting the prescriber for dose adjustment or
monitoring plan is prudent prior to first dose. This action
reflects safe medication administration and anticipatory
monitoring per Karch’s pharmacokinetic principles.
Rationales — Incorrect:
A. Monitoring after giving is reactive and risks adverse effects;
dose adjustment should be considered first.
C. A snack may affect absorption for some drugs but does not
address increased free drug due to hypoalbuminemia.
D. Splitting without prescriber approval can alter
pharmacokinetics and is unsafe.
Teaching Point: Low albumin increases free drug — consider
dose reduction or prescriber notification.
Citation: Tucker, R. G. (2026). Karch’s Focus on Nursing
Pharmacology (10th ed.). Ch. 1.
2)
Reference: Ch. 1 — Introduction to Drugs
Stem: A postoperative client requests their PRN opioid for
increasing pain. The nurse notes the client received a
,benzodiazepine 30 minutes ago for anxiety. What should the
nurse do first?
A. Give the opioid and document concurrent benzodiazepine
use.
B. Hold the opioid and re-assess respiratory rate and sedation
level now.
C. Offer nonpharmacologic pain measures and give the opioid
later.
D. Contact the prescriber to cancel the opioid order.
Correct Answer: B
Rationale — Correct (B): Opioids and benzodiazepines have
additive CNS-depressant effects; first action is to assess for
sedation and respiratory depression prior to additional dosing.
Nursing assessment determines safety of administering another
sedating medication.
Rationales — Incorrect:
A. Administering without reassessment risks respiratory
compromise.
C. Nonpharmacologic measures are useful but first ensure it’s
safe to give more sedating medication.
D. Canceling without assessment or prescriber contact is
premature.
Teaching Point: Always assess sedation and respiratory status
before giving additional CNS depressants.
Citation: Tucker, R. G. (2026). Karch’s Focus on Nursing
Pharmacology (10th ed.). Ch. 1.
, 3)
Reference: Ch. 1 — Introduction to Drugs
Stem: A client with new prescriptions asks why one drug is
given IV and another orally. The nurse explains absorption
differences. Which explanation best describes first-pass effect?
A. IV drugs are destroyed by the liver before reaching systemic
circulation.
B. Oral drugs are metabolized in the liver, reducing their
bioavailability.
C. Drugs given IM bypass the liver and have decreased effect.
D. Sublingual drugs have more drug lost to first-pass
metabolism.
Correct Answer: B
Rationale — Correct (B): The first-pass effect refers to hepatic
metabolism of orally absorbed drugs before they reach systemic
circulation, decreasing bioavailability—an essential
pharmacokinetic concept nurses teach patients.
Rationales — Incorrect:
A. IV drugs bypass the first-pass effect; they are not destroyed
by the liver before systemic circulation.
C. IM drugs generally bypass first-pass hepatic metabolism and
often have good bioavailability.
D. Sublingual administration bypasses the first-pass effect, not
increases it.
PHARMACOLOGY
10TH EDITION
• AUTHOR(S)REBECCA G. TUCKER
TEST BANK
1)
Reference: Ch. 1 — Introduction to Drugs
Stem: A 72-year-old client with chronic heart failure (ejection
fraction 30%) is prescribed a new oral medication that is highly
protein-bound. The nurse notes the client has low serum
albumin (2.5 g/dL). Which nursing action is most appropriate
before administering the first dose?
A. Give the dose and monitor blood pressure hourly.
B. Hold the dose and contact the prescriber to discuss a lower
dose.
,C. Administer the dose with a light snack to improve absorption.
D. Split the tablet and give half now and half in 12 hours.
Correct Answer: B
Rationale — Correct (B): Low albumin increases the free
fraction of highly protein-bound drugs, raising risk of toxicity.
Holding and contacting the prescriber for dose adjustment or
monitoring plan is prudent prior to first dose. This action
reflects safe medication administration and anticipatory
monitoring per Karch’s pharmacokinetic principles.
Rationales — Incorrect:
A. Monitoring after giving is reactive and risks adverse effects;
dose adjustment should be considered first.
C. A snack may affect absorption for some drugs but does not
address increased free drug due to hypoalbuminemia.
D. Splitting without prescriber approval can alter
pharmacokinetics and is unsafe.
Teaching Point: Low albumin increases free drug — consider
dose reduction or prescriber notification.
Citation: Tucker, R. G. (2026). Karch’s Focus on Nursing
Pharmacology (10th ed.). Ch. 1.
2)
Reference: Ch. 1 — Introduction to Drugs
Stem: A postoperative client requests their PRN opioid for
increasing pain. The nurse notes the client received a
,benzodiazepine 30 minutes ago for anxiety. What should the
nurse do first?
A. Give the opioid and document concurrent benzodiazepine
use.
B. Hold the opioid and re-assess respiratory rate and sedation
level now.
C. Offer nonpharmacologic pain measures and give the opioid
later.
D. Contact the prescriber to cancel the opioid order.
Correct Answer: B
Rationale — Correct (B): Opioids and benzodiazepines have
additive CNS-depressant effects; first action is to assess for
sedation and respiratory depression prior to additional dosing.
Nursing assessment determines safety of administering another
sedating medication.
Rationales — Incorrect:
A. Administering without reassessment risks respiratory
compromise.
C. Nonpharmacologic measures are useful but first ensure it’s
safe to give more sedating medication.
D. Canceling without assessment or prescriber contact is
premature.
Teaching Point: Always assess sedation and respiratory status
before giving additional CNS depressants.
Citation: Tucker, R. G. (2026). Karch’s Focus on Nursing
Pharmacology (10th ed.). Ch. 1.
, 3)
Reference: Ch. 1 — Introduction to Drugs
Stem: A client with new prescriptions asks why one drug is
given IV and another orally. The nurse explains absorption
differences. Which explanation best describes first-pass effect?
A. IV drugs are destroyed by the liver before reaching systemic
circulation.
B. Oral drugs are metabolized in the liver, reducing their
bioavailability.
C. Drugs given IM bypass the liver and have decreased effect.
D. Sublingual drugs have more drug lost to first-pass
metabolism.
Correct Answer: B
Rationale — Correct (B): The first-pass effect refers to hepatic
metabolism of orally absorbed drugs before they reach systemic
circulation, decreasing bioavailability—an essential
pharmacokinetic concept nurses teach patients.
Rationales — Incorrect:
A. IV drugs bypass the first-pass effect; they are not destroyed
by the liver before systemic circulation.
C. IM drugs generally bypass first-pass hepatic metabolism and
often have good bioavailability.
D. Sublingual administration bypasses the first-pass effect, not
increases it.
