Focus on Nursing Pharmacology 8th
Edition by Karch TestBank
PART 1: FOUNDATIONS OF PHARMACOLOGY
1. A nursing student asks the instructor to explain the difference between pharmacokinetics
and pharmacodynamics. Which response by the instructor is most accurate?
A. Pharmacokinetics is how a drug affects the body; pharmacodynamics is how the body acts on
the drug
B. Pharmacokinetics is how the body acts on the drug; pharmacodynamics is how a drug affects
the body
C. Both terms describe the chemical name of a drug
D. Both terms refer exclusively to the FDA approval process
Correct Answer: B
Rationale: Pharmacokinetics describes absorption, distribution, metabolism, and
excretion—how the body processes a drug. Pharmacodynamics describes the biochemical and
physiologic effects of drugs on the body. Chemical names and FDA approval are unrelated to
these definitions.
2. A patient is prescribed a drug that has completed Phase III clinical trials and received FDA
approval for marketing. Which phase of drug evaluation is the patient now participating in?
A. Phase I
B. Phase II
C. Phase III
D. Phase IV
Correct Answer: D
Rationale: Phase IV (post-marketing surveillance) occurs after FDA approval and monitors
long-term safety, efficacy, and rare adverse effects in the general population. Phases I–III occur
before approval.
3. A patient taking oral nitroglycerin reports that the drug does not relieve angina. The nurse
suspects that extensive first-pass hepatic metabolism is inactivating the drug before it reaches
systemic circulation. Which pharmacokinetic process is responsible?
,A. Absorption
B. Metabolism
C. Distribution
D. Excretion
Correct Answer: B
Rationale: First-pass effect (metabolism) occurs when a drug is absorbed from the GI tract
and transported via the portal vein to the liver, where a significant portion is metabolized before
reaching systemic circulation. Nitroglycerin has extensive first-pass metabolism, necessitating
sublingual or transdermal routes.
4. A patient receiving gentamicin has a peak level of 12 mcg/mL and a trough level of 3
mcg/mL. The therapeutic range for peak is 5–10 mcg/mL and for trough is <2 mcg/mL. Which
nursing action is priority?
A. Continue the current dosing schedule
B. Hold the next dose and notify the prescriber
C. Administer the next dose immediately
D. Increase the dose to achieve a higher peak
Correct Answer: B
Rationale: The elevated trough (3 mcg/mL) exceeds the safe limit of <2 mcg/mL, indicating
drug accumulation and increased risk of nephrotoxicity and ototoxicity. The nurse must hold the
dose and notify the prescriber to adjust the regimen.
5. A patient develops a severe rash and anaphylaxis after receiving a penicillin injection. This
reaction was not predicted by the drug's pharmacologic profile. Which type of adverse drug
reaction (ADR) has occurred?
A. Type A (augmented/predictable)
B. Type B (bizarre/idiosyncratic)
C. Type C (chronic)
D. Type D (delayed)
Correct Answer: B
Rationale: Type B (bizarre) reactions are unpredictable, dose-independent, and often
immunologically mediated. Type A reactions are predictable extensions of pharmacologic
effects; Type C occurs with chronic use; Type D manifests after prolonged latency.
,6. A nurse is administering warfarin and notices the patient is also receiving aspirin for
arthritis. The nurse recognizes that the combined effect increases bleeding risk beyond what
either drug produces alone. Which type of drug interaction is this?
A. Additive
B. Synergistic
C. Antagonistic
D. Incompatibility
Correct Answer: B
Rationale: A synergistic interaction occurs when two drugs produce an effect greater than
the sum of their individual effects. Warfarin and aspirin both affect bleeding pathways; their
combination creates exponentially increased bleeding risk.
7. A nurse is reviewing a drug with a Category X pregnancy rating. What is the appropriate
nursing action?
A. Administer only during the third trimester
B. Instruct patient to avoid alcohol while taking the drug
C. Inform the patient that the drug is safe in low doses
D. Inform the patient that the drug is contraindicated during pregnancy
Correct Answer: D
Rationale: Category X drugs are proven to cause fetal abnormalities and are contraindicated
in pregnancy. The risk of use clearly outweighs any possible benefit.
8. A nurse is assessing the patient's home medication use. After listening to the patient list
current medications, the nurse asks what priority question?
A. "Do you take any generic medications?"
B. "Are any of these medications orphan drugs?"
C. "Are these medications safe to take during pregnancy?"
D. "Do you take any over-the-counter medications?"
Correct Answer: D
Rationale: It is important for the nurse to specifically question use of over-the-counter
medications because patients may not consider them important or may not think of them as
"real" medications. OTC drugs can interact with prescribed medications.
9. Which statement about generic drugs is accurate?
, A. They are chemically different from brand-name drugs
B. They are less effective than brand-name versions
C. They may have different inactive ingredients than the brand-name version
D. They cost more due to increased testing requirements
Correct Answer: C
Rationale: Generic drugs have the same active ingredients but may contain different binders
or fillers that can affect absorption in some patients. They are bioequivalent but not identical in
inactive ingredients.
10. During drug development, what is the purpose of Phase I clinical trials?
A. To determine safety and dosage in healthy volunteers
B. To identify the drug's market potential
C. To evaluate effectiveness in large populations
D. To assess teratogenic effects
Correct Answer: A
Rationale: Phase I trials focus on drug safety and dosage in a small group of healthy
individuals before testing in patients. Phase II evaluates effectiveness, and Phase III involves
large-scale testing.
11. A nurse is caring for a patient who has been receiving a drug by the intramuscular route
but will receive the drug orally after discharge. The patient asks why the oral dose is higher.
What is the nurse's best response?
A. "Oral drugs are absorbed more completely than IM drugs."
B. "The oral dose is higher to account for the first-pass effect."
C. "IM drugs are always more potent than oral drugs."
D. "The oral form is less concentrated than the injectable form."
Correct Answer: B
Rationale: The first-pass effect involves drugs absorbed from the small intestine directly into
the portal venous system, which delivers drug molecules to the liver. Enzymes break the drug
into metabolites, and a large percentage of the oral dose is destroyed before reaching tissues.
Oral dosages account for this phenomenon to ensure therapeutic drug levels.
12. A patient with Parkinson's disease is taking an anticholinergic drug to decrease tremors
and drooling. The patient complains of difficulty voiding. The nurse would explain that this is
what?
Edition by Karch TestBank
PART 1: FOUNDATIONS OF PHARMACOLOGY
1. A nursing student asks the instructor to explain the difference between pharmacokinetics
and pharmacodynamics. Which response by the instructor is most accurate?
A. Pharmacokinetics is how a drug affects the body; pharmacodynamics is how the body acts on
the drug
B. Pharmacokinetics is how the body acts on the drug; pharmacodynamics is how a drug affects
the body
C. Both terms describe the chemical name of a drug
D. Both terms refer exclusively to the FDA approval process
Correct Answer: B
Rationale: Pharmacokinetics describes absorption, distribution, metabolism, and
excretion—how the body processes a drug. Pharmacodynamics describes the biochemical and
physiologic effects of drugs on the body. Chemical names and FDA approval are unrelated to
these definitions.
2. A patient is prescribed a drug that has completed Phase III clinical trials and received FDA
approval for marketing. Which phase of drug evaluation is the patient now participating in?
A. Phase I
B. Phase II
C. Phase III
D. Phase IV
Correct Answer: D
Rationale: Phase IV (post-marketing surveillance) occurs after FDA approval and monitors
long-term safety, efficacy, and rare adverse effects in the general population. Phases I–III occur
before approval.
3. A patient taking oral nitroglycerin reports that the drug does not relieve angina. The nurse
suspects that extensive first-pass hepatic metabolism is inactivating the drug before it reaches
systemic circulation. Which pharmacokinetic process is responsible?
,A. Absorption
B. Metabolism
C. Distribution
D. Excretion
Correct Answer: B
Rationale: First-pass effect (metabolism) occurs when a drug is absorbed from the GI tract
and transported via the portal vein to the liver, where a significant portion is metabolized before
reaching systemic circulation. Nitroglycerin has extensive first-pass metabolism, necessitating
sublingual or transdermal routes.
4. A patient receiving gentamicin has a peak level of 12 mcg/mL and a trough level of 3
mcg/mL. The therapeutic range for peak is 5–10 mcg/mL and for trough is <2 mcg/mL. Which
nursing action is priority?
A. Continue the current dosing schedule
B. Hold the next dose and notify the prescriber
C. Administer the next dose immediately
D. Increase the dose to achieve a higher peak
Correct Answer: B
Rationale: The elevated trough (3 mcg/mL) exceeds the safe limit of <2 mcg/mL, indicating
drug accumulation and increased risk of nephrotoxicity and ototoxicity. The nurse must hold the
dose and notify the prescriber to adjust the regimen.
5. A patient develops a severe rash and anaphylaxis after receiving a penicillin injection. This
reaction was not predicted by the drug's pharmacologic profile. Which type of adverse drug
reaction (ADR) has occurred?
A. Type A (augmented/predictable)
B. Type B (bizarre/idiosyncratic)
C. Type C (chronic)
D. Type D (delayed)
Correct Answer: B
Rationale: Type B (bizarre) reactions are unpredictable, dose-independent, and often
immunologically mediated. Type A reactions are predictable extensions of pharmacologic
effects; Type C occurs with chronic use; Type D manifests after prolonged latency.
,6. A nurse is administering warfarin and notices the patient is also receiving aspirin for
arthritis. The nurse recognizes that the combined effect increases bleeding risk beyond what
either drug produces alone. Which type of drug interaction is this?
A. Additive
B. Synergistic
C. Antagonistic
D. Incompatibility
Correct Answer: B
Rationale: A synergistic interaction occurs when two drugs produce an effect greater than
the sum of their individual effects. Warfarin and aspirin both affect bleeding pathways; their
combination creates exponentially increased bleeding risk.
7. A nurse is reviewing a drug with a Category X pregnancy rating. What is the appropriate
nursing action?
A. Administer only during the third trimester
B. Instruct patient to avoid alcohol while taking the drug
C. Inform the patient that the drug is safe in low doses
D. Inform the patient that the drug is contraindicated during pregnancy
Correct Answer: D
Rationale: Category X drugs are proven to cause fetal abnormalities and are contraindicated
in pregnancy. The risk of use clearly outweighs any possible benefit.
8. A nurse is assessing the patient's home medication use. After listening to the patient list
current medications, the nurse asks what priority question?
A. "Do you take any generic medications?"
B. "Are any of these medications orphan drugs?"
C. "Are these medications safe to take during pregnancy?"
D. "Do you take any over-the-counter medications?"
Correct Answer: D
Rationale: It is important for the nurse to specifically question use of over-the-counter
medications because patients may not consider them important or may not think of them as
"real" medications. OTC drugs can interact with prescribed medications.
9. Which statement about generic drugs is accurate?
, A. They are chemically different from brand-name drugs
B. They are less effective than brand-name versions
C. They may have different inactive ingredients than the brand-name version
D. They cost more due to increased testing requirements
Correct Answer: C
Rationale: Generic drugs have the same active ingredients but may contain different binders
or fillers that can affect absorption in some patients. They are bioequivalent but not identical in
inactive ingredients.
10. During drug development, what is the purpose of Phase I clinical trials?
A. To determine safety and dosage in healthy volunteers
B. To identify the drug's market potential
C. To evaluate effectiveness in large populations
D. To assess teratogenic effects
Correct Answer: A
Rationale: Phase I trials focus on drug safety and dosage in a small group of healthy
individuals before testing in patients. Phase II evaluates effectiveness, and Phase III involves
large-scale testing.
11. A nurse is caring for a patient who has been receiving a drug by the intramuscular route
but will receive the drug orally after discharge. The patient asks why the oral dose is higher.
What is the nurse's best response?
A. "Oral drugs are absorbed more completely than IM drugs."
B. "The oral dose is higher to account for the first-pass effect."
C. "IM drugs are always more potent than oral drugs."
D. "The oral form is less concentrated than the injectable form."
Correct Answer: B
Rationale: The first-pass effect involves drugs absorbed from the small intestine directly into
the portal venous system, which delivers drug molecules to the liver. Enzymes break the drug
into metabolites, and a large percentage of the oral dose is destroyed before reaching tissues.
Oral dosages account for this phenomenon to ensure therapeutic drug levels.
12. A patient with Parkinson's disease is taking an anticholinergic drug to decrease tremors
and drooling. The patient complains of difficulty voiding. The nurse would explain that this is
what?
