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 has a
narrow therapeutic index. The client's laboratory results
,indicate the current serum drug level is at the upper limit of
the therapeutic range. Which action should the nurse
prioritize?
A. Administer the medication as prescribed.
B. Hold the medication and notify the healthcare provider.
C. Assess the client for signs of drug toxicity.
D. Verify the medication order with the pharmacist.
Correct Answer: C
Rationale: A narrow therapeutic index means there is a small
margin between the effective dose and the toxic dose. When a
drug level is at the upper limit of the therapeutic range, the
client is at significant risk for toxicity. The nurse's priority is to
assess for signs of toxicity before making a decision about
administration. This demonstrates the application of the
nursing process and medication safety principles.
Why the Other Options Are Incorrect
A. Administering the medication without first assessing for
toxicity is unsafe and could lead to adverse effects.
B. While notifying the provider may be necessary, the priority
is to first assess the client's status.
D. Verifying the order with the pharmacist is a good practice
but does not address the immediate safety concern regarding
the drug level.
,Learning Objective: Apply the concept of a narrow therapeutic
index to clinical decision-making and patient assessment.
Bloom's Taxonomy: Analyze
Difficulty: Moderate
NCLEX Client Needs Category: Pharmacological and Parenteral
Therapies
NCJMM Clinical Judgment Skill: Recognize Cues
Question 2
A client with a history of asthma is prescribed a new
medication. The nurse notes that the medication is a
cholinergic agonist. Which assessment finding would indicate
a potential adverse effect of this drug that is of greatest
concern for this client?
A. Increased heart rate
B. Bronchoconstriction
C. Urinary retention
D. Pupil dilation
Correct Answer: B
Rationale: Cholinergic agonists stimulate the parasympathetic
nervous system, leading to effects such as
bronchoconstriction, increased secretions, and decreased
, heart rate. For a client with asthma, bronchoconstriction is a
dangerous adverse effect that could trigger an asthma attack.
This question requires the nurse to recall the mechanism of
action of cholinergic agonists and apply it to a specific patient
population.
Why the Other Options Are Incorrect
A. Cholinergic agonists typically cause bradycardia, not
tachycardia. Tachycardia is an effect of adrenergic agonists.
C. Urinary retention is a potential effect of anticholinergic
agents, which block the parasympathetic system.
D. Pupil dilation (mydriasis) is also an effect of anticholinergic
agents, not cholinergic agonists.
Learning Objective: Predict adverse effects of cholinergic
agonists in a patient with a respiratory condition.
Bloom's Taxonomy: Analyze
Difficulty: Moderate
NCLEX Client Needs Category: Pharmacological and Parenteral
Therapies
NCJMM Clinical Judgment Skill: Analyze Cues
Question 3
Pharmacology
9th Edition
Author(s)Rebecca G. Tucker
TEST BANK
Question 1
A nurse is preparing to administer a medication that has a
narrow therapeutic index. The client's laboratory results
,indicate the current serum drug level is at the upper limit of
the therapeutic range. Which action should the nurse
prioritize?
A. Administer the medication as prescribed.
B. Hold the medication and notify the healthcare provider.
C. Assess the client for signs of drug toxicity.
D. Verify the medication order with the pharmacist.
Correct Answer: C
Rationale: A narrow therapeutic index means there is a small
margin between the effective dose and the toxic dose. When a
drug level is at the upper limit of the therapeutic range, the
client is at significant risk for toxicity. The nurse's priority is to
assess for signs of toxicity before making a decision about
administration. This demonstrates the application of the
nursing process and medication safety principles.
Why the Other Options Are Incorrect
A. Administering the medication without first assessing for
toxicity is unsafe and could lead to adverse effects.
B. While notifying the provider may be necessary, the priority
is to first assess the client's status.
D. Verifying the order with the pharmacist is a good practice
but does not address the immediate safety concern regarding
the drug level.
,Learning Objective: Apply the concept of a narrow therapeutic
index to clinical decision-making and patient assessment.
Bloom's Taxonomy: Analyze
Difficulty: Moderate
NCLEX Client Needs Category: Pharmacological and Parenteral
Therapies
NCJMM Clinical Judgment Skill: Recognize Cues
Question 2
A client with a history of asthma is prescribed a new
medication. The nurse notes that the medication is a
cholinergic agonist. Which assessment finding would indicate
a potential adverse effect of this drug that is of greatest
concern for this client?
A. Increased heart rate
B. Bronchoconstriction
C. Urinary retention
D. Pupil dilation
Correct Answer: B
Rationale: Cholinergic agonists stimulate the parasympathetic
nervous system, leading to effects such as
bronchoconstriction, increased secretions, and decreased
, heart rate. For a client with asthma, bronchoconstriction is a
dangerous adverse effect that could trigger an asthma attack.
This question requires the nurse to recall the mechanism of
action of cholinergic agonists and apply it to a specific patient
population.
Why the Other Options Are Incorrect
A. Cholinergic agonists typically cause bradycardia, not
tachycardia. Tachycardia is an effect of adrenergic agonists.
C. Urinary retention is a potential effect of anticholinergic
agents, which block the parasympathetic system.
D. Pupil dilation (mydriasis) is also an effect of anticholinergic
agents, not cholinergic agonists.
Learning Objective: Predict adverse effects of cholinergic
agonists in a patient with a respiratory condition.
Bloom's Taxonomy: Analyze
Difficulty: Moderate
NCLEX Client Needs Category: Pharmacological and Parenteral
Therapies
NCJMM Clinical Judgment Skill: Analyze Cues
Question 3
