,Plusbay.Plus
,3. The nurse is teaching a patient who will be discharged home with a prescription for an
enteric- coated tablet. Which statement by the patient indicates understanding of the teaching?
a. I may crush the tablet and put it in applesauce to improve absorption.
b. I should consume acidic foods to enhance absorption of this medication.
c. I should expect a delay in onset of the drugs effects after taking the tablet.
d. I should take this medication with high-fat foods to improve its
action. ANS: C
Enteric-coated tablets resist disintegration in the acidic environment of the stomach and
disintegrate when they reach the small intestine. There is usually some delay in onset of actions
after taking these medications. Enteric-coated tablets should not be crushed or chewed, which
would alter the time and location of absorption. Acidic foods will not enhance the absorption of
the medication. The patient should not to eat high-fat food before ingesting an enteric-coated
tablet, because high-fat foods decrease the absorption rate.
DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 3
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
4. A patient who is newly diagnosed with type 1 diabetes mellitus asks why insulin must be
given by subcutaneous injection instead of by mouth. The nurse will explain that this is
because
a. absorption is diminished by the first-pass effects in the liver.
b. absorption is faster when insulin is given subcutaneously.
c. digestive enzymes in the gastrointestinal tract prevent absorption.
d. the oral form is less predictable with more adverse
effects. ANS: C
Insulin, growth hormones, and other protein-based drugs are destroyed in the small intestine by
digestive enzymes and must be given parenterally. Because insulin is destroyed by digestive
enzymes, it would not make it to the liver for metabolism with a first-pass effect. Subcutaneous
tissue has fewer blood vessels, so absorption is slower in such tissue. Insulin is given
subcutaneously because it is desirable to have it absorb slowly.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 3
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
Page 2 of 507
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,5. The nurse is preparing to administer an oral medication that is water-soluble. The
nurse understands that this drug
a. must be taken on an empty stomach.
b. requires active transport for absorption.
c. should be taken with fatty foods.
d. will readily diffuse into the gastrointestinal
tract. ANS: B
Water-soluble drugs require a carrier enzyme or protein to pass through the GI membrane.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 4
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
6. A nurse is preparing to administer an oral drug that is best absorbed in an acidic
environment. How will the nurse give the drug?
a. On an empty stomach
b. With a full glass of water
c. With food
d. With high-fat
food ANS: C
Food can stimulate the production of gastric acid so medications requiring an acidic
environment should be given with a meal. High-fat foods are useful for drugs that are lipid
soluble.
DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 4
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
7. The nurse is preparing an injectable drug and wants to administer it for rapid absorption.
How will the nurse give this medication?
a. IM into the deltoid muscle
b. IM into the gluteal muscle
c. SubQ into abdominal tissue
d. SubQ into the upper
arm ANS: A
Page 3 of 507
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,Drugs given IM are absorbed faster in muscles that have more blood vessels, such as the deltoid, rather than
those with fewer blood vessels, such as the gluteals. Subcutaneous routes are used when
absorption needs to be slower and more sustained.
DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 4 TOP:
NURSING PROCESS: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
8. The nurse is reviewing medication information with a nursing student prior to
administering an oral drug and notes that the drug has extensive first-pass effects. Which
statement by the student indicates a need for further teaching about this medication?
a. The first-pass effect means the drug may be absorbed into systemic circulation from
the intestinal lumen.
b. The first-pass effect means the drug may be changed to an inactive form and excreted.
c. The first-pass effect means the drug may be changed to a metabolite, which may be
more active than the original.
d. The first-pass effect means the drug may be unchanged as it passes through the liver.
ANS: A
Drugs that undergo first-pass metabolism are absorbed into the portal vein from the intestinal lumen and go
through the liver where they are either unchanged or are metabolized to an inactive or a more
active form.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 4 TOP:
NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
9. The nurse prepares to change a patients medication from an intravenous to an oral form
and notes that the oral form is ordered in a higher dose. The nurse understands that this is
due to differences in
a. bioavailability.
b. pinocytosis.
c. protein binding.
d. tachyphylaxis.
ANS: A
Page 4 of 507
Plusbay.Plus
, Oral drugs may have less bioavailability because a lower percentage of the drug reaches the systemic
circulation. Pinocytosis refers to the process by which cells carry a solute across a membrane.
Protein binding can occur with both routes. Tachyphylaxis describes a rapid decrease in
response to drugs that occurs when tolerance develops quickly.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 4 TOP:
NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
10. The nurse is preparing to administer a drug and learns that it binds to protein at a rate of 90%.
The patients serum albumin level is low. The nurse will observe the patient for
a. decreased drug absorption.
b. decreased drug interactions.
c. decreased drug toxicity.
d. increased drug
effects. ANS: D
Drugs that are highly protein-bound bind with albumin and other proteins, leaving less free drug in
circulation. If a patient has a low albumin, the drug is not bound, and there is more free drug to
cause drug effects. There would be increased absorption, increased interactions with other
drugs, and increased toxicity.
DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 5 TOP:
NURSING PROCESS: Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
11. The nurse is administering two drugs to a patient and learns that both drugs are
highly protein-bound. The nurse may expect
a. decreased bioavailability of both drugs.
b. decreased drug effects.
c. decreased drug interactions.
d. increased risk of adverse
effects. ANS: D
Two drugs that are highly protein-bound will compete for protein-binding sites, leaving more
Page 5 of 507
Plusbay.Plus
,3. The nurse is teaching a patient who will be discharged home with a prescription for an
enteric- coated tablet. Which statement by the patient indicates understanding of the teaching?
a. I may crush the tablet and put it in applesauce to improve absorption.
b. I should consume acidic foods to enhance absorption of this medication.
c. I should expect a delay in onset of the drugs effects after taking the tablet.
d. I should take this medication with high-fat foods to improve its
action. ANS: C
Enteric-coated tablets resist disintegration in the acidic environment of the stomach and
disintegrate when they reach the small intestine. There is usually some delay in onset of actions
after taking these medications. Enteric-coated tablets should not be crushed or chewed, which
would alter the time and location of absorption. Acidic foods will not enhance the absorption of
the medication. The patient should not to eat high-fat food before ingesting an enteric-coated
tablet, because high-fat foods decrease the absorption rate.
DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 3
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
4. A patient who is newly diagnosed with type 1 diabetes mellitus asks why insulin must be
given by subcutaneous injection instead of by mouth. The nurse will explain that this is
because
a. absorption is diminished by the first-pass effects in the liver.
b. absorption is faster when insulin is given subcutaneously.
c. digestive enzymes in the gastrointestinal tract prevent absorption.
d. the oral form is less predictable with more adverse
effects. ANS: C
Insulin, growth hormones, and other protein-based drugs are destroyed in the small intestine by
digestive enzymes and must be given parenterally. Because insulin is destroyed by digestive
enzymes, it would not make it to the liver for metabolism with a first-pass effect. Subcutaneous
tissue has fewer blood vessels, so absorption is slower in such tissue. Insulin is given
subcutaneously because it is desirable to have it absorb slowly.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 3
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
Page 2 of 507
Plusbay.Plus
,5. The nurse is preparing to administer an oral medication that is water-soluble. The
nurse understands that this drug
a. must be taken on an empty stomach.
b. requires active transport for absorption.
c. should be taken with fatty foods.
d. will readily diffuse into the gastrointestinal
tract. ANS: B
Water-soluble drugs require a carrier enzyme or protein to pass through the GI membrane.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 4
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
6. A nurse is preparing to administer an oral drug that is best absorbed in an acidic
environment. How will the nurse give the drug?
a. On an empty stomach
b. With a full glass of water
c. With food
d. With high-fat
food ANS: C
Food can stimulate the production of gastric acid so medications requiring an acidic
environment should be given with a meal. High-fat foods are useful for drugs that are lipid
soluble.
DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 4
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
7. The nurse is preparing an injectable drug and wants to administer it for rapid absorption.
How will the nurse give this medication?
a. IM into the deltoid muscle
b. IM into the gluteal muscle
c. SubQ into abdominal tissue
d. SubQ into the upper
arm ANS: A
Page 3 of 507
Plusbay.Plus
,Drugs given IM are absorbed faster in muscles that have more blood vessels, such as the deltoid, rather than
those with fewer blood vessels, such as the gluteals. Subcutaneous routes are used when
absorption needs to be slower and more sustained.
DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 4 TOP:
NURSING PROCESS: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
8. The nurse is reviewing medication information with a nursing student prior to
administering an oral drug and notes that the drug has extensive first-pass effects. Which
statement by the student indicates a need for further teaching about this medication?
a. The first-pass effect means the drug may be absorbed into systemic circulation from
the intestinal lumen.
b. The first-pass effect means the drug may be changed to an inactive form and excreted.
c. The first-pass effect means the drug may be changed to a metabolite, which may be
more active than the original.
d. The first-pass effect means the drug may be unchanged as it passes through the liver.
ANS: A
Drugs that undergo first-pass metabolism are absorbed into the portal vein from the intestinal lumen and go
through the liver where they are either unchanged or are metabolized to an inactive or a more
active form.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 4 TOP:
NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
9. The nurse prepares to change a patients medication from an intravenous to an oral form
and notes that the oral form is ordered in a higher dose. The nurse understands that this is
due to differences in
a. bioavailability.
b. pinocytosis.
c. protein binding.
d. tachyphylaxis.
ANS: A
Page 4 of 507
Plusbay.Plus
, Oral drugs may have less bioavailability because a lower percentage of the drug reaches the systemic
circulation. Pinocytosis refers to the process by which cells carry a solute across a membrane.
Protein binding can occur with both routes. Tachyphylaxis describes a rapid decrease in
response to drugs that occurs when tolerance develops quickly.
DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: dm 4 TOP:
NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
10. The nurse is preparing to administer a drug and learns that it binds to protein at a rate of 90%.
The patients serum albumin level is low. The nurse will observe the patient for
a. decreased drug absorption.
b. decreased drug interactions.
c. decreased drug toxicity.
d. increased drug
effects. ANS: D
Drugs that are highly protein-bound bind with albumin and other proteins, leaving less free drug in
circulation. If a patient has a low albumin, the drug is not bound, and there is more free drug to
cause drug effects. There would be increased absorption, increased interactions with other
drugs, and increased toxicity.
DIF: COGNITIVE LEVEL: Applying (Application) REF: dm 5 TOP:
NURSING PROCESS: Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies
11. The nurse is administering two drugs to a patient and learns that both drugs are
highly protein-bound. The nurse may expect
a. decreased bioavailability of both drugs.
b. decreased drug effects.
c. decreased drug interactions.
d. increased risk of adverse
effects. ANS: D
Two drugs that are highly protein-bound will compete for protein-binding sites, leaving more
Page 5 of 507
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