Test Bank for Lehne’s Pharmacology for Nursing Care 11th Edition by Jacqueline
Rosenjack Burchum & Laura D. Rosenthal | 2026/2027 Latest Update | Complete
Chapter Questions & Answers with Rationales | Verified Questions & Answers |
Graded A+ NCLEX Pharma
SECTION I: BASIC PRINCIPLES OF PHARMACOLOGY (Questions 1–15)
1. A nurse is preparing to administer a drug that undergoes extensive first-pass hepatic
metabolism. Which route of administration would avoid this effect?
A. Oral
B. Sublingual
C. Rectal
D. Enteral
Correct Answer: B. Sublingual
Rationale: Sublingual administration bypasses the hepatic portal circulation by allowing the
drug to be absorbed directly into the systemic circulation through the venous drainage under
the tongue. This avoids first-pass metabolism by the liver. Oral, rectal, and enteral routes all
deliver drugs to the portal circulation, subjecting them to varying degrees of first-pass
metabolism.
2. A patient is prescribed a drug with a narrow therapeutic index. Which nursing action is
most appropriate?
A. Administer the drug without regard to timing
B. Monitor serum drug levels closely
C. Double the dose if the patient does not respond quickly
D. Discontinue the drug if any side effect occurs
Correct Answer: B. Monitor serum drug levels closely
Rationale: A narrow therapeutic index means the difference between therapeutic and toxic
doses is small. Close monitoring of serum drug levels is essential to maintain concentrations
within the therapeutic range and avoid toxicity. Drugs such as digoxin, lithium, and phenytoin
require such monitoring.
3. Which statement best describes the mechanism of a drug that acts as a competitive
antagonist?
A. It binds to the receptor and activates a response
B. It binds to the receptor and prevents the agonist from binding
,C. It binds to plasma proteins and reduces free drug concentration
D. It irreversibly destroys the receptor
Correct Answer: B. It binds to the receptor and prevents the agonist from binding
Rationale: A competitive antagonist binds reversibly to the same receptor site as the
agonist, preventing the agonist from producing its effect. The blockade can be overcome by
increasing the concentration of the agonist. Non-competitive antagonists bind irreversibly or at
a different site.
4. A nurse is teaching a patient about a drug that is a potent inducer of cytochrome P450
enzymes. Which instruction is essential?
A. Expect increased effects of other medications
B. Avoid all other medications
C. Be aware that other drugs may have reduced effectiveness
D. Take the medication only with food
Correct Answer: C. Be aware that other drugs may have reduced effectiveness
Rationale: CYP450 inducers increase the metabolism of substrate drugs, potentially
reducing their therapeutic effect. Examples of inducers include rifampin, phenytoin, and
carbamazepine. Patients must be monitored for loss of efficacy of concomitant medications.
5. Which factor most significantly affects drug distribution?
A. Gastric pH
B. Blood flow to tissues and protein binding
C. Rate of renal excretion
D. Activity of hepatic enzymes
Correct Answer: B. Blood flow to tissues and protein binding
Rationale: Distribution is affected by blood flow to tissues (highest to brain, heart, liver,
kidneys) and the degree of protein binding. Only the unbound (free) drug can leave the vascular
space and exert effects. Alterations in protein binding (e.g., hypoalbuminemia) can increase free
drug levels and toxicity risk.
6. A patient with renal impairment is prescribed a drug that is primarily excreted unchanged
by the kidneys. What should the nurse anticipate?
A. An increased dose is required
B. The drug will accumulate and toxicity may occur
,C. The drug will be metabolized by the liver instead
D. No dosage adjustment is needed
Correct Answer: B. The drug will accumulate and toxicity may occur
Rationale: When renal function is impaired, drugs eliminated unchanged by the kidneys will
have prolonged half-lives and accumulate, increasing the risk of toxicity. Dosage reduction or
extended dosing intervals are typically required.
7. Which term describes the time required for the plasma concentration of a drug to decrease
by 50%?
A. Onset of action
B. Half-life
C. Peak effect
D. Duration of action
Correct Answer: B. Half-life
Rationale: Half-life (t½) is the time required for the amount of drug in the body to decrease
by half. It determines the time to steady state (approximately 5 half-lives) and the dosing
interval.
8. A patient asks why a medication must be taken at the same time every day. The nurse's
best response is based on which principle?
A. To prevent allergic reactions
B. To maintain therapeutic plasma concentrations
C. To reduce the cost of medication
D. To enhance the drug's taste
Correct Answer: B. To maintain therapeutic plasma concentrations
Rationale: Consistent dosing maintains plasma drug concentrations within the therapeutic
range, avoiding subtherapeutic (ineffective) or toxic levels. This is especially important for drugs
with short half-lives or narrow therapeutic indices.
9. (SATA) Which factors can alter a patient's response to a drug? Select all that apply.
A. Age
B. Body weight
C. Genetic variations in metabolism
D. Route of administration
E. The color of the medication
, Correct Answers: A, B, C, D
Rationale: Age (especially extremes), body weight, genetic polymorphisms (e.g., CYP450
variants), and route of administration all significantly affect drug response. The color of the
medication has no pharmacologic effect.
10. A nurse is assessing a patient for adverse drug reactions. Which finding most likely
represents an idiosyncratic reaction?
A. Nausea after chemotherapy
B. Bradycardia after a beta-blocker
C. Aplastic anemia after chloramphenicol
D. Drowsiness after an antihistamine
Correct Answer: C. Aplastic anemia after chloramphenicol
Rationale: An idiosyncratic reaction is an unpredictable, genetically determined abnormal
response unrelated to the drug's known pharmacologic action. Aplastic anemia from
chloramphenicol is a classic example. The other options are predictable, dose-related effects.
11. Which drug schedule classification indicates a high potential for abuse and no accepted
medical use in the United States?
A. Schedule I
B. Schedule II
C. Schedule III
D. Schedule IV
Correct Answer: A. Schedule I
Rationale: Schedule I drugs (e.g., heroin, LSD, marijuana) have high abuse potential and no
currently accepted medical use. Schedule II drugs have high abuse potential but accepted
medical uses with severe restrictions.
12. A patient who has been taking a drug with a half-life of 12 hours stops taking it abruptly.
Approximately how long will it take for the drug to be almost completely eliminated?
A. 12 hours
B. 24 hours
C. 36 hours
D. 60 hours
Correct Answer: D. 60 hours
Rosenjack Burchum & Laura D. Rosenthal | 2026/2027 Latest Update | Complete
Chapter Questions & Answers with Rationales | Verified Questions & Answers |
Graded A+ NCLEX Pharma
SECTION I: BASIC PRINCIPLES OF PHARMACOLOGY (Questions 1–15)
1. A nurse is preparing to administer a drug that undergoes extensive first-pass hepatic
metabolism. Which route of administration would avoid this effect?
A. Oral
B. Sublingual
C. Rectal
D. Enteral
Correct Answer: B. Sublingual
Rationale: Sublingual administration bypasses the hepatic portal circulation by allowing the
drug to be absorbed directly into the systemic circulation through the venous drainage under
the tongue. This avoids first-pass metabolism by the liver. Oral, rectal, and enteral routes all
deliver drugs to the portal circulation, subjecting them to varying degrees of first-pass
metabolism.
2. A patient is prescribed a drug with a narrow therapeutic index. Which nursing action is
most appropriate?
A. Administer the drug without regard to timing
B. Monitor serum drug levels closely
C. Double the dose if the patient does not respond quickly
D. Discontinue the drug if any side effect occurs
Correct Answer: B. Monitor serum drug levels closely
Rationale: A narrow therapeutic index means the difference between therapeutic and toxic
doses is small. Close monitoring of serum drug levels is essential to maintain concentrations
within the therapeutic range and avoid toxicity. Drugs such as digoxin, lithium, and phenytoin
require such monitoring.
3. Which statement best describes the mechanism of a drug that acts as a competitive
antagonist?
A. It binds to the receptor and activates a response
B. It binds to the receptor and prevents the agonist from binding
,C. It binds to plasma proteins and reduces free drug concentration
D. It irreversibly destroys the receptor
Correct Answer: B. It binds to the receptor and prevents the agonist from binding
Rationale: A competitive antagonist binds reversibly to the same receptor site as the
agonist, preventing the agonist from producing its effect. The blockade can be overcome by
increasing the concentration of the agonist. Non-competitive antagonists bind irreversibly or at
a different site.
4. A nurse is teaching a patient about a drug that is a potent inducer of cytochrome P450
enzymes. Which instruction is essential?
A. Expect increased effects of other medications
B. Avoid all other medications
C. Be aware that other drugs may have reduced effectiveness
D. Take the medication only with food
Correct Answer: C. Be aware that other drugs may have reduced effectiveness
Rationale: CYP450 inducers increase the metabolism of substrate drugs, potentially
reducing their therapeutic effect. Examples of inducers include rifampin, phenytoin, and
carbamazepine. Patients must be monitored for loss of efficacy of concomitant medications.
5. Which factor most significantly affects drug distribution?
A. Gastric pH
B. Blood flow to tissues and protein binding
C. Rate of renal excretion
D. Activity of hepatic enzymes
Correct Answer: B. Blood flow to tissues and protein binding
Rationale: Distribution is affected by blood flow to tissues (highest to brain, heart, liver,
kidneys) and the degree of protein binding. Only the unbound (free) drug can leave the vascular
space and exert effects. Alterations in protein binding (e.g., hypoalbuminemia) can increase free
drug levels and toxicity risk.
6. A patient with renal impairment is prescribed a drug that is primarily excreted unchanged
by the kidneys. What should the nurse anticipate?
A. An increased dose is required
B. The drug will accumulate and toxicity may occur
,C. The drug will be metabolized by the liver instead
D. No dosage adjustment is needed
Correct Answer: B. The drug will accumulate and toxicity may occur
Rationale: When renal function is impaired, drugs eliminated unchanged by the kidneys will
have prolonged half-lives and accumulate, increasing the risk of toxicity. Dosage reduction or
extended dosing intervals are typically required.
7. Which term describes the time required for the plasma concentration of a drug to decrease
by 50%?
A. Onset of action
B. Half-life
C. Peak effect
D. Duration of action
Correct Answer: B. Half-life
Rationale: Half-life (t½) is the time required for the amount of drug in the body to decrease
by half. It determines the time to steady state (approximately 5 half-lives) and the dosing
interval.
8. A patient asks why a medication must be taken at the same time every day. The nurse's
best response is based on which principle?
A. To prevent allergic reactions
B. To maintain therapeutic plasma concentrations
C. To reduce the cost of medication
D. To enhance the drug's taste
Correct Answer: B. To maintain therapeutic plasma concentrations
Rationale: Consistent dosing maintains plasma drug concentrations within the therapeutic
range, avoiding subtherapeutic (ineffective) or toxic levels. This is especially important for drugs
with short half-lives or narrow therapeutic indices.
9. (SATA) Which factors can alter a patient's response to a drug? Select all that apply.
A. Age
B. Body weight
C. Genetic variations in metabolism
D. Route of administration
E. The color of the medication
, Correct Answers: A, B, C, D
Rationale: Age (especially extremes), body weight, genetic polymorphisms (e.g., CYP450
variants), and route of administration all significantly affect drug response. The color of the
medication has no pharmacologic effect.
10. A nurse is assessing a patient for adverse drug reactions. Which finding most likely
represents an idiosyncratic reaction?
A. Nausea after chemotherapy
B. Bradycardia after a beta-blocker
C. Aplastic anemia after chloramphenicol
D. Drowsiness after an antihistamine
Correct Answer: C. Aplastic anemia after chloramphenicol
Rationale: An idiosyncratic reaction is an unpredictable, genetically determined abnormal
response unrelated to the drug's known pharmacologic action. Aplastic anemia from
chloramphenicol is a classic example. The other options are predictable, dose-related effects.
11. Which drug schedule classification indicates a high potential for abuse and no accepted
medical use in the United States?
A. Schedule I
B. Schedule II
C. Schedule III
D. Schedule IV
Correct Answer: A. Schedule I
Rationale: Schedule I drugs (e.g., heroin, LSD, marijuana) have high abuse potential and no
currently accepted medical use. Schedule II drugs have high abuse potential but accepted
medical uses with severe restrictions.
12. A patient who has been taking a drug with a half-life of 12 hours stops taking it abruptly.
Approximately how long will it take for the drug to be almost completely eliminated?
A. 12 hours
B. 24 hours
C. 36 hours
D. 60 hours
Correct Answer: D. 60 hours
