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 man is admitted with community-acquired
pneumonia. His medication list includes warfarin for atrial
fibrillation and several OTC supplements. The primary provider
orders azithromycin. Which action should the nurse take first?
A. Administer the azithromycin and continue warfarin as
ordered.
B. Hold warfarin until pharmacist verifies interaction and check
,INR.
C. Ask the provider to change azithromycin to doxycycline
because of bleeding risk.
D. Teach the patient to stop OTC supplements while
hospitalized.
Correct answer
B
Rationale — Correct (B)
Azithromycin can potentiate warfarin’s anticoagulant effect in
older adults, increasing bleeding risk. The nurse’s first action is
to hold or at least verify warfarin orders and check INR while
consulting pharmacy or provider. This prioritizes patient safety
and monitoring consistent with nursing responsibilities in drug–
drug interaction management.
Rationale — Incorrect
A. Unsafe: administering without checking increases bleeding
risk; nurse must anticipate interactions.
C. Incomplete: changing antibiotic is a prescriber decision after
assessing interactions and infection coverage.
D. Lower priority: stopping supplements is important but
secondary to immediate anticoagulation monitoring.
Teaching point
Always verify potential drug–drug interactions and obtain
relevant labs before administering interacting drugs.
,Citation
Tucker, R. G. (2026). Karch’s Focus on Nursing Pharmacology
(10th ed.). Ch. 1.
2
Reference
Ch. 1 — Introduction to Drugs
Stem
A nurse is teaching a 28-year-old woman who will start a new
antiseizure medication that has a long half-life and requires
steady-state monitoring. The patient asks why blood levels are
needed and how long before levels stabilize. What is the nurse’s
best explanation?
A. “Blood levels aren’t necessary; just take it as directed and
report side effects.”
B. “Because the drug accumulates, levels stabilize after about
4–5 half-lives; monitoring prevents toxicity.”
C. “We check levels weekly until you feel better.”
D. “You’ll need a loading dose so levels are therapeutic
immediately and monitoring isn’t needed.”
Correct answer
B
Rationale — Correct (B)
Explaining steady state in terms of half-lives is accurate and
emphasizes prevention of toxicity. Many antiseizure drugs
, require level monitoring until steady state (about 4–5 half-lives)
to balance efficacy and safety — a core pharmacokinetic
concept nurses teach.
Rationale — Incorrect
A. Unsafe and dismissive: fails to teach monitoring and risk of
toxicity.
C. Vague and incorrect: weekly checks may be unnecessary or
insufficient depending on half-life; timing should relate to half-
lives.
D. Incorrect: loading doses may be used for some drugs, but
cannot be generalized; monitoring may still be required.
Teaching point
Steady state usually occurs after ~4–5 half-lives; levels guide
safe dosing and prevent toxicity.
Citation
Tucker, R. G. (2026). Karch’s Focus on Nursing Pharmacology
(10th ed.). Ch. 1.
3
Reference
Ch. 1 — Introduction to Drugs
Stem
A postoperative patient is prescribed morphine via PCA. The
patient is elderly and has reduced renal function (creatinine
PHARMACOLOGY
10TH EDITION
• AUTHOR(S)REBECCA G. TUCKER
TEST BANK
1
Reference
Ch. 1 — Introduction to Drugs
Stem
A 72-year-old man is admitted with community-acquired
pneumonia. His medication list includes warfarin for atrial
fibrillation and several OTC supplements. The primary provider
orders azithromycin. Which action should the nurse take first?
A. Administer the azithromycin and continue warfarin as
ordered.
B. Hold warfarin until pharmacist verifies interaction and check
,INR.
C. Ask the provider to change azithromycin to doxycycline
because of bleeding risk.
D. Teach the patient to stop OTC supplements while
hospitalized.
Correct answer
B
Rationale — Correct (B)
Azithromycin can potentiate warfarin’s anticoagulant effect in
older adults, increasing bleeding risk. The nurse’s first action is
to hold or at least verify warfarin orders and check INR while
consulting pharmacy or provider. This prioritizes patient safety
and monitoring consistent with nursing responsibilities in drug–
drug interaction management.
Rationale — Incorrect
A. Unsafe: administering without checking increases bleeding
risk; nurse must anticipate interactions.
C. Incomplete: changing antibiotic is a prescriber decision after
assessing interactions and infection coverage.
D. Lower priority: stopping supplements is important but
secondary to immediate anticoagulation monitoring.
Teaching point
Always verify potential drug–drug interactions and obtain
relevant labs before administering interacting drugs.
,Citation
Tucker, R. G. (2026). Karch’s Focus on Nursing Pharmacology
(10th ed.). Ch. 1.
2
Reference
Ch. 1 — Introduction to Drugs
Stem
A nurse is teaching a 28-year-old woman who will start a new
antiseizure medication that has a long half-life and requires
steady-state monitoring. The patient asks why blood levels are
needed and how long before levels stabilize. What is the nurse’s
best explanation?
A. “Blood levels aren’t necessary; just take it as directed and
report side effects.”
B. “Because the drug accumulates, levels stabilize after about
4–5 half-lives; monitoring prevents toxicity.”
C. “We check levels weekly until you feel better.”
D. “You’ll need a loading dose so levels are therapeutic
immediately and monitoring isn’t needed.”
Correct answer
B
Rationale — Correct (B)
Explaining steady state in terms of half-lives is accurate and
emphasizes prevention of toxicity. Many antiseizure drugs
, require level monitoring until steady state (about 4–5 half-lives)
to balance efficacy and safety — a core pharmacokinetic
concept nurses teach.
Rationale — Incorrect
A. Unsafe and dismissive: fails to teach monitoring and risk of
toxicity.
C. Vague and incorrect: weekly checks may be unnecessary or
insufficient depending on half-life; timing should relate to half-
lives.
D. Incorrect: loading doses may be used for some drugs, but
cannot be generalized; monitoring may still be required.
Teaching point
Steady state usually occurs after ~4–5 half-lives; levels guide
safe dosing and prevent toxicity.
Citation
Tucker, R. G. (2026). Karch’s Focus on Nursing Pharmacology
(10th ed.). Ch. 1.
3
Reference
Ch. 1 — Introduction to Drugs
Stem
A postoperative patient is prescribed morphine via PCA. The
patient is elderly and has reduced renal function (creatinine
