Pharmacology: A Patient-Centered Nursing
Process Approach 12th Edition Test Bank &
NCLEX Review | 58 Chapters | Questions &
Answers | McCuistion et al
SECTION 1: INTRODUCTION TO PHARMACOLOGY
Question 1
A nurse is reviewing the clinical judgment measurement model as it applies to
medication administration. Which action best reflects the "recognize cues" step?
A. Comparing the patient's current blood pressure to the previous reading after
administering an antihypertensive
B. Deciding to hold a beta-blocker because the heart rate is 52 bpm
C. Reviewing the medication administration record for due medications
D. Teaching the patient about the purpose of a newly prescribed medication
Correct Answer: C. Reviewing the medication administration record for
due medications
Rationale: "Recognize cues" is the first step of the clinical judgment
model, which involves identifying relevant data from the patient situation.
Reviewing the MAR to identify due medications is an example of recognizing
relevant cues before taking action. Option A represents "evaluate outcomes,"
Option B reflects "take action," and Option D represents "generate solutions"
through patient education.
Question 2
A nurse is preparing to administer a medication to a patient with hepatic
impairment. Which pharmacokinetic process is most directly affected?
A. Absorption
B. Distribution
,C. Metabolism
D. Excretion
Correct Answer: C. Metabolism
Rationale: The liver is the primary site of drug metabolism
(biotransformation). Hepatic impairment reduces the liver's ability to metabolize
drugs, leading to drug accumulation and potential toxicity. While distribution may
be affected by altered protein binding, metabolism is the most directly impacted
process.
Question 3
A patient asks the nurse why a lower dose of a drug is needed when administered
intravenously compared to orally. Which principle should guide the nurse's
response?
A. Intravenous drugs have a longer half-life
B. Oral drugs undergo first-pass metabolism in the liver
C. Intravenous drugs are more protein-bound
D. Oral drugs have higher bioavailability
Correct Answer: B. Oral drugs undergo first-pass metabolism in the liver
Rationale: The first-pass effect refers to the metabolism of a drug by the
liver before it reaches systemic circulation. Orally administered drugs are
absorbed from the GI tract and transported via the portal vein to the liver, where
a portion is metabolized before reaching target tissues. Intravenous
administration bypasses this first-pass effect, requiring lower doses to achieve
therapeutic effects. Bioavailability of oral drugs is typically lower than IV drugs.
Question 4
A nurse is calculating a safe dose range for a pediatric patient. Which factor most
significantly influences drug dosing in children compared to adults?
,A. Higher gastric pH in children
B. Immature hepatic enzyme systems
C. Decreased total body water percentage
D. Increased plasma protein binding
Correct Answer: B. Immature hepatic enzyme systems
Rationale: Pediatric patients, especially neonates and infants, have
immature hepatic enzyme systems (cytochrome P450), which slows drug
metabolism and prolongs drug action. Children also have a higher percentage of
total body water (not decreased), and plasma protein binding is often decreased
due to lower albumin levels.
Question 5
A nurse is assessing an older adult patient who takes multiple medications. Which
age-related change most increases the risk for drug toxicity?
A. Increased gastric motility
B. Decreased glomerular filtration rate
C. Increased hepatic blood flow
D. Decreased body fat percentage
Correct Answer: B. Decreased glomerular filtration rate
Rationale: Aging is associated with a decline in renal function, including
decreased glomerular filtration rate and renal blood flow. This reduces drug
excretion, leading to drug accumulation and increased risk of toxicity. Older adults
also have decreased gastric motility (not increased), decreased hepatic blood
flow, and increased body fat percentage (which increases distribution of lipid-
soluble drugs).
Question 6
A patient is prescribed a drug that is highly protein-bound. The nurse should
monitor for which potential drug interaction?
, A. Increased drug effect if another highly protein-bound drug is administered
concurrently
B. Decreased drug effect if albumin levels are elevated
C. Increased drug effect if albumin levels are decreased
D. No change in drug effect regardless of protein binding
Correct Answer: C. Increased drug effect if albumin levels are decreased
Rationale: Only unbound (free) drug is pharmacologically active. When
albumin levels are low (e.g., malnutrition, liver disease), fewer binding sites are
available, leaving more free drug available to exert effects and potentially cause
toxicity. Concurrent administration of another highly protein-bound drug would
displace the first drug, increasing its free fraction and effect.
Question 7 (SATA)
A nurse is teaching a patient about a new prescription. Which factors increase the
risk for adverse drug reactions? Select all that apply.
A. Polypharmacy
B. Genetic polymorphisms in drug-metabolizing enzymes
C. Normal renal and hepatic function
D. Age older than 65 years
E. Use of herbal supplements
Correct Answer: A, B, D, E
Rationale: Polypharmacy, genetic variations in CYP450 enzymes, advanced
age, and concurrent herbal supplement use all increase the risk for adverse drug
reactions. Normal renal and hepatic function actually decrease risk by ensuring
proper drug metabolism and excretion. Herbal supplements can interact with
drugs through enzyme induction or inhibition.
Question 8
Process Approach 12th Edition Test Bank &
NCLEX Review | 58 Chapters | Questions &
Answers | McCuistion et al
SECTION 1: INTRODUCTION TO PHARMACOLOGY
Question 1
A nurse is reviewing the clinical judgment measurement model as it applies to
medication administration. Which action best reflects the "recognize cues" step?
A. Comparing the patient's current blood pressure to the previous reading after
administering an antihypertensive
B. Deciding to hold a beta-blocker because the heart rate is 52 bpm
C. Reviewing the medication administration record for due medications
D. Teaching the patient about the purpose of a newly prescribed medication
Correct Answer: C. Reviewing the medication administration record for
due medications
Rationale: "Recognize cues" is the first step of the clinical judgment
model, which involves identifying relevant data from the patient situation.
Reviewing the MAR to identify due medications is an example of recognizing
relevant cues before taking action. Option A represents "evaluate outcomes,"
Option B reflects "take action," and Option D represents "generate solutions"
through patient education.
Question 2
A nurse is preparing to administer a medication to a patient with hepatic
impairment. Which pharmacokinetic process is most directly affected?
A. Absorption
B. Distribution
,C. Metabolism
D. Excretion
Correct Answer: C. Metabolism
Rationale: The liver is the primary site of drug metabolism
(biotransformation). Hepatic impairment reduces the liver's ability to metabolize
drugs, leading to drug accumulation and potential toxicity. While distribution may
be affected by altered protein binding, metabolism is the most directly impacted
process.
Question 3
A patient asks the nurse why a lower dose of a drug is needed when administered
intravenously compared to orally. Which principle should guide the nurse's
response?
A. Intravenous drugs have a longer half-life
B. Oral drugs undergo first-pass metabolism in the liver
C. Intravenous drugs are more protein-bound
D. Oral drugs have higher bioavailability
Correct Answer: B. Oral drugs undergo first-pass metabolism in the liver
Rationale: The first-pass effect refers to the metabolism of a drug by the
liver before it reaches systemic circulation. Orally administered drugs are
absorbed from the GI tract and transported via the portal vein to the liver, where
a portion is metabolized before reaching target tissues. Intravenous
administration bypasses this first-pass effect, requiring lower doses to achieve
therapeutic effects. Bioavailability of oral drugs is typically lower than IV drugs.
Question 4
A nurse is calculating a safe dose range for a pediatric patient. Which factor most
significantly influences drug dosing in children compared to adults?
,A. Higher gastric pH in children
B. Immature hepatic enzyme systems
C. Decreased total body water percentage
D. Increased plasma protein binding
Correct Answer: B. Immature hepatic enzyme systems
Rationale: Pediatric patients, especially neonates and infants, have
immature hepatic enzyme systems (cytochrome P450), which slows drug
metabolism and prolongs drug action. Children also have a higher percentage of
total body water (not decreased), and plasma protein binding is often decreased
due to lower albumin levels.
Question 5
A nurse is assessing an older adult patient who takes multiple medications. Which
age-related change most increases the risk for drug toxicity?
A. Increased gastric motility
B. Decreased glomerular filtration rate
C. Increased hepatic blood flow
D. Decreased body fat percentage
Correct Answer: B. Decreased glomerular filtration rate
Rationale: Aging is associated with a decline in renal function, including
decreased glomerular filtration rate and renal blood flow. This reduces drug
excretion, leading to drug accumulation and increased risk of toxicity. Older adults
also have decreased gastric motility (not increased), decreased hepatic blood
flow, and increased body fat percentage (which increases distribution of lipid-
soluble drugs).
Question 6
A patient is prescribed a drug that is highly protein-bound. The nurse should
monitor for which potential drug interaction?
, A. Increased drug effect if another highly protein-bound drug is administered
concurrently
B. Decreased drug effect if albumin levels are elevated
C. Increased drug effect if albumin levels are decreased
D. No change in drug effect regardless of protein binding
Correct Answer: C. Increased drug effect if albumin levels are decreased
Rationale: Only unbound (free) drug is pharmacologically active. When
albumin levels are low (e.g., malnutrition, liver disease), fewer binding sites are
available, leaving more free drug available to exert effects and potentially cause
toxicity. Concurrent administration of another highly protein-bound drug would
displace the first drug, increasing its free fraction and effect.
Question 7 (SATA)
A nurse is teaching a patient about a new prescription. Which factors increase the
risk for adverse drug reactions? Select all that apply.
A. Polypharmacy
B. Genetic polymorphisms in drug-metabolizing enzymes
C. Normal renal and hepatic function
D. Age older than 65 years
E. Use of herbal supplements
Correct Answer: A, B, D, E
Rationale: Polypharmacy, genetic variations in CYP450 enzymes, advanced
age, and concurrent herbal supplement use all increase the risk for adverse drug
reactions. Normal renal and hepatic function actually decrease risk by ensuring
proper drug metabolism and excretion. Herbal supplements can interact with
drugs through enzyme induction or inhibition.
Question 8
