KARCH’S FOCUS ON NURSING
PHARMACOLOGY
10TH EDITION
• AUTHOR(S)REBECCA G. TUCKER
TEST BANK
1
Reference: Ch. 1 — Introduction to Drugs
Stem: A 68-year-old man is admitted with confusion and a new
prescription for a drug that is highly protein bound. His serum
albumin is low. The nurse notes his current medication list
includes several other highly protein-bound drugs. What should
the nurse do first?
A. Administer the new drug and monitor for therapeutic
response.
B. Hold the new drug and notify the prescriber about low
albumin and interaction risk.
,C. Give the new drug at a reduced dose without notifying
prescriber.
D. Schedule an extra serum drug level 48 hours after
administration.
Correct answer: B
Rationale — Correct: Holding the drug and notifying the
prescriber is first because hypoalbuminemia increases free
(active) drug fraction for highly protein-bound drugs and co-
administration with other highly bound drugs can displace
binding, raising toxicity risk. Nursing assessment and
communication prevent harm and align with safe medication
administration principles.
Rationale — Incorrect:
A. Unsafe—administering without addressing increased free
drug risks toxicity.
C. Incorrect—arbitrarily reducing dose may underdose or still
cause toxicity; prescriber decision needed.
D. Lower priority—monitoring alone after administration misses
opportunity to prevent harm.
Teaching point: Low albumin increases free drug levels; notify
prescriber before administration.
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 prepares to give an oral, enteric-coated tablet to
a patient who reports difficulty swallowing whole pills. The
patient asks if the tablet can be crushed. What is the best
nursing action?
A. Crush the tablet and mix with applesauce to aid swallowing.
B. Request a formulation change (liquid or immediate-release)
from prescriber or pharmacist.
C. Tell the patient to try swallowing with a larger sip of water.
D. Open the capsule and sprinkle contents on food to facilitate
administration.
Correct answer: B
Rationale — Correct: Enteric-coated tablets are designed to
bypass gastric acid and crushing them destroys the coating,
altering absorption and possibly causing harm. The nurse
should request an alternative formulation (liquid or immediate-
release) from prescriber/pharmacist to ensure safety and
correct bioavailability.
Rationale — Incorrect:
A. Incorrect—crushing enteric-coated tablets can cause
irritation or altered absorption.
C. Incomplete—may not be possible for patient and doesn’t
address formulation issue.
D. Incorrect—opening capsules may alter pharmacokinetics;
only done if manufacturer/prescriber allows.
, Teaching point: Never crush enteric-coated or sustained-release
forms without provider/pharmacy approval.
Citation: Tucker, R. G. (2026). Karch’s Focus on Nursing
Pharmacology (10th ed.). Ch. 1.
3
Reference: Ch. 1 — Introduction to Drugs
Stem: A patient starting a medication with a known long half-
life asks why it takes several days to see benefit. Which nursing
explanation best reflects pharmacokinetic principles?
A. “The liver needs time to activate the drug.”
B. “The drug must reach steady state, which takes about 4–5
half-lives.”
C. “Your body must produce antibodies to the drug first.”
D. “The drug slowly dissolves in your stomach over days.”
Correct answer: B
Rationale — Correct: Explaining steady state (about 4–5 half-
lives) correctly communicates that serum drug levels
accumulate over time until input equals elimination; long half-
life delays steady state and therapeutic effect. This is accurate
pharmacokinetic reasoning for patient teaching.
Rationale — Incorrect:
A. Incorrect—only prodrugs require activation; not general
explanation for half-life.
PHARMACOLOGY
10TH EDITION
• AUTHOR(S)REBECCA G. TUCKER
TEST BANK
1
Reference: Ch. 1 — Introduction to Drugs
Stem: A 68-year-old man is admitted with confusion and a new
prescription for a drug that is highly protein bound. His serum
albumin is low. The nurse notes his current medication list
includes several other highly protein-bound drugs. What should
the nurse do first?
A. Administer the new drug and monitor for therapeutic
response.
B. Hold the new drug and notify the prescriber about low
albumin and interaction risk.
,C. Give the new drug at a reduced dose without notifying
prescriber.
D. Schedule an extra serum drug level 48 hours after
administration.
Correct answer: B
Rationale — Correct: Holding the drug and notifying the
prescriber is first because hypoalbuminemia increases free
(active) drug fraction for highly protein-bound drugs and co-
administration with other highly bound drugs can displace
binding, raising toxicity risk. Nursing assessment and
communication prevent harm and align with safe medication
administration principles.
Rationale — Incorrect:
A. Unsafe—administering without addressing increased free
drug risks toxicity.
C. Incorrect—arbitrarily reducing dose may underdose or still
cause toxicity; prescriber decision needed.
D. Lower priority—monitoring alone after administration misses
opportunity to prevent harm.
Teaching point: Low albumin increases free drug levels; notify
prescriber before administration.
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 prepares to give an oral, enteric-coated tablet to
a patient who reports difficulty swallowing whole pills. The
patient asks if the tablet can be crushed. What is the best
nursing action?
A. Crush the tablet and mix with applesauce to aid swallowing.
B. Request a formulation change (liquid or immediate-release)
from prescriber or pharmacist.
C. Tell the patient to try swallowing with a larger sip of water.
D. Open the capsule and sprinkle contents on food to facilitate
administration.
Correct answer: B
Rationale — Correct: Enteric-coated tablets are designed to
bypass gastric acid and crushing them destroys the coating,
altering absorption and possibly causing harm. The nurse
should request an alternative formulation (liquid or immediate-
release) from prescriber/pharmacist to ensure safety and
correct bioavailability.
Rationale — Incorrect:
A. Incorrect—crushing enteric-coated tablets can cause
irritation or altered absorption.
C. Incomplete—may not be possible for patient and doesn’t
address formulation issue.
D. Incorrect—opening capsules may alter pharmacokinetics;
only done if manufacturer/prescriber allows.
, Teaching point: Never crush enteric-coated or sustained-release
forms without provider/pharmacy approval.
Citation: Tucker, R. G. (2026). Karch’s Focus on Nursing
Pharmacology (10th ed.). Ch. 1.
3
Reference: Ch. 1 — Introduction to Drugs
Stem: A patient starting a medication with a known long half-
life asks why it takes several days to see benefit. Which nursing
explanation best reflects pharmacokinetic principles?
A. “The liver needs time to activate the drug.”
B. “The drug must reach steady state, which takes about 4–5
half-lives.”
C. “Your body must produce antibodies to the drug first.”
D. “The drug slowly dissolves in your stomach over days.”
Correct answer: B
Rationale — Correct: Explaining steady state (about 4–5 half-
lives) correctly communicates that serum drug levels
accumulate over time until input equals elimination; long half-
life delays steady state and therapeutic effect. This is accurate
pharmacokinetic reasoning for patient teaching.
Rationale — Incorrect:
A. Incorrect—only prodrugs require activation; not general
explanation for half-life.
