Karch’s Focus on Nursing
Pharmacology
9th Edition
Author(s)Rebecca G. Tucker
TEST BANK
Question 1
A nurse is preparing to administer a medication that is known to
have a narrow therapeutic index. The nurse reviews the
patient's chart and notes the current serum drug level. Which
action is most important for the nurse to take to ensure patient
safety?
,A. Administer the medication with food to enhance absorption.
B. Monitor the patient's vital signs before and after
administration.
C. Verify that the prescribed dose is within the standard range
and hold the drug if levels are toxic.
D. Assess the patient's level of pain.
Correct Answer: C. Verify that the prescribed dose is within the
standard range and hold the drug if levels are toxic.
Rationale: Drugs with a narrow therapeutic index have a small
margin of safety and a small window between therapeutic and
toxic doses. The most critical nursing action is to review the
prescribed dose in the context of the patient's current serum
drug level to ensure it is safe and therapeutic . The nurse must
use clinical judgment to hold the medication and notify the
provider if the level is in a toxic range.
Why the Other Options Are Incorrect
A. Administering with food is a general administration
consideration and does not address the immediate safety
concern related to the drug's level.
B. Monitoring vital signs is a standard nursing action but is not
the most important action compared to verifying the dose
against a toxic serum level.
D. Pain assessment is appropriate for some medications but is
,irrelevant to the core safety concern of a narrow therapeutic
index.
Learning Objective: Identify nursing implications for
medications with a narrow therapeutic index.
Bloom's Taxonomy: Apply
Difficulty: Easy
NCLEX Client Needs Category: Pharmacological and Parenteral
Therapies
NCJMM Clinical Judgment Skill: Recognize Cues
Question 2
The nurse is reviewing the medication history of a patient who
is being started on a new drug. Which patient statement would
be the highest priority for the nurse to report to the healthcare
provider?
A. "I take a daily multivitamin with iron."
B. "I use an over-the-counter antacid for heartburn sometimes."
C. "I am taking St. John's wort for depression."
D. "I have a glass of red wine with dinner each night."
Correct Answer: C. "I am taking St. John's wort for depression."
Rationale: St. John's wort is a potent herbal supplement known
to induce the cytochrome P450 enzyme system, particularly
, CYP3A4. This can lead to significant drug interactions, reducing
the effectiveness of many prescription drugs, including
warfarin, oral contraceptives, and antidepressants . The
potential for a serious interaction makes this the highest
priority to report.
Why the Other Options Are Incorrect
A. While iron can interact with some drugs (e.g., tetracyclines)
by reducing their absorption, it is not as high a priority as a
potent enzyme inducer.
B. Antacids can affect the absorption of certain drugs, but this
interaction is generally manageable and less critical than a
CYP3A4 induction.
D. Moderate alcohol consumption can have interactions, but it
is not as immediately impactful as the significant drug
interactions caused by St. John's wort.
Learning Objective: Evaluate the potential for drug interactions
with herbal supplements.
Bloom's Taxonomy: Analyze
Difficulty: Moderate
NCLEX Client Needs Category: Pharmacological and Parenteral
Therapies
NCJMM Clinical Judgment Skill: Recognize Cues
Pharmacology
9th Edition
Author(s)Rebecca G. Tucker
TEST BANK
Question 1
A nurse is preparing to administer a medication that is known to
have a narrow therapeutic index. The nurse reviews the
patient's chart and notes the current serum drug level. Which
action is most important for the nurse to take to ensure patient
safety?
,A. Administer the medication with food to enhance absorption.
B. Monitor the patient's vital signs before and after
administration.
C. Verify that the prescribed dose is within the standard range
and hold the drug if levels are toxic.
D. Assess the patient's level of pain.
Correct Answer: C. Verify that the prescribed dose is within the
standard range and hold the drug if levels are toxic.
Rationale: Drugs with a narrow therapeutic index have a small
margin of safety and a small window between therapeutic and
toxic doses. The most critical nursing action is to review the
prescribed dose in the context of the patient's current serum
drug level to ensure it is safe and therapeutic . The nurse must
use clinical judgment to hold the medication and notify the
provider if the level is in a toxic range.
Why the Other Options Are Incorrect
A. Administering with food is a general administration
consideration and does not address the immediate safety
concern related to the drug's level.
B. Monitoring vital signs is a standard nursing action but is not
the most important action compared to verifying the dose
against a toxic serum level.
D. Pain assessment is appropriate for some medications but is
,irrelevant to the core safety concern of a narrow therapeutic
index.
Learning Objective: Identify nursing implications for
medications with a narrow therapeutic index.
Bloom's Taxonomy: Apply
Difficulty: Easy
NCLEX Client Needs Category: Pharmacological and Parenteral
Therapies
NCJMM Clinical Judgment Skill: Recognize Cues
Question 2
The nurse is reviewing the medication history of a patient who
is being started on a new drug. Which patient statement would
be the highest priority for the nurse to report to the healthcare
provider?
A. "I take a daily multivitamin with iron."
B. "I use an over-the-counter antacid for heartburn sometimes."
C. "I am taking St. John's wort for depression."
D. "I have a glass of red wine with dinner each night."
Correct Answer: C. "I am taking St. John's wort for depression."
Rationale: St. John's wort is a potent herbal supplement known
to induce the cytochrome P450 enzyme system, particularly
, CYP3A4. This can lead to significant drug interactions, reducing
the effectiveness of many prescription drugs, including
warfarin, oral contraceptives, and antidepressants . The
potential for a serious interaction makes this the highest
priority to report.
Why the Other Options Are Incorrect
A. While iron can interact with some drugs (e.g., tetracyclines)
by reducing their absorption, it is not as high a priority as a
potent enzyme inducer.
B. Antacids can affect the absorption of certain drugs, but this
interaction is generally manageable and less critical than a
CYP3A4 induction.
D. Moderate alcohol consumption can have interactions, but it
is not as immediately impactful as the significant drug
interactions caused by St. John's wort.
Learning Objective: Evaluate the potential for drug interactions
with herbal supplements.
Bloom's Taxonomy: Analyze
Difficulty: Moderate
NCLEX Client Needs Category: Pharmacological and Parenteral
Therapies
NCJMM Clinical Judgment Skill: Recognize Cues
