,Chapter 02: Basic Principles of Drug Action and Drug Interactions
Willihnganz: Clayton’s Basic Pharmacology for Nurses, 18th Edition
MULTIPLE CHOICE
1. The nurse assesses hives in a patient started on a new medication. What is the nurse’s priority
action?
a. Notify physician of allergic reaction.
b. Notify physician of idiosyncratic reaction.
c. Notify physician of potential teratogenicity.
d. Notify physician of potential tolerance.
ANS: A
An allergic reaction is indicative of hypersensitivity and manifests with hives and/or urticaria,
which are easily identified. An idiosyncratic reaction occurs when something unusual or
abnormal happens when a drug is first administered. A teratogenic reaction refers to the
occurrence of birth defects related to administration of the drug. Tolerance refers to the body’s
requirement for increasing dosages to achieve the same effects that a lower dose once did.
DIF: Cognitive Level: Application REF: p. 17 OBJ: 4
NAT: NCLEX Client Needs Category: Physiological Integrity
TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety
2. The nurse administers an initial dose of a steroid to a patient with asthma. Thirty minutes after
administration, the nurse finds the patient agitated and stating that “everyone is out to get me.”
What is the term for this unusual reaction?
a. Desired action
b. Adverse effect
c. Idiosyncratic reaction
d. Allergic reaction
ANS: C
Idiosyncratic reactions are unusual, abnormal reactions that occur when a drug is first
administered. Patients typically exhibit an overresponsiveness to a medication related to
diminished metabolism. These reactions are believed to be related to genetic enzyme
deficiencies. Desired actions are expected responses to a medication. Adverse effects are
reactions that occur in another system of the body; they are usually predictable. Allergic
reactions appear after repeated medication dosages.
DIF: Cognitive Level: Knowledge REF: p. 18 OBJ: 4
NAT: NCLEX Client Needs Category: Physiological Integrity
TOP: Nursing Process Step: Evaluation
CON: Patient Education | Clinical Judgment | Caregiving | Safety | Sensory Perception
3. Which is the best description of when drug interactions occur?
a. On administration of toxic dosages of a drug
b. On an increase in the pharmacodynamics of bound drugs
c. On the alteration of the effect of one drug by another drug
d. On increase of drug excretion
ANS: C
, Drug interactions may be characterized by an increase or decrease in the effectiveness of one
or both of the drugs. Toxicity of one drug may or may not affect the metabolism of another
one. Drug interactions may result from either increased or decreased pharmacodynamics.
Drug interactions may result from either increased or decreased excretion.
DIF: Cognitive Level: Comprehension REF: p. 18 OBJ: 5
NAT: NCLEX Client Needs Category: Physiological Integrity
TOP: Nursing Process Step: Assessment CON: Safety | Patient Education | Clinical Judgment
4. What occurs when two drugs compete for the same receptor site, resulting in increased
activity of the first drug?
a. Desired action
b. Synergistic effect
c. Carcinogenicity
d. Displacement
ANS: D
The displacement of the first drug from receptor sites by a second drug increases the amount
of the first drug because more unbound drug is available. An expected response of a drug is
the desired action. A synergistic effect is the effect of two drugs being greater than the effect
of each chemical individually or the sum of the individual effects. Carcinogenicity is the
ability of a drug to cause cells to mutate and become cancerous.
DIF: Cognitive Level: Comprehension REF: p. 19 OBJ: 6
NAT: NCLEX Client Needs Category: Physiological Integrity
TOP: Nursing Process Step: Implementation CON: Safety | Patient Education
5. What do drug blood levels indicate?
a. They confirm if the patient is taking a generic form of a drug.
b. They determine if the patient has sufficient body fat to metabolize the drug.
c. They verify if the patient is taking someone else’s medications.
d. They determine if the amount of drug in the body is in a therapeutic range.
ANS: D
The amount of drug present may vary over time and the blood level must remain in a
therapeutic range in order to obtain the desired result. Generic drugs do not necessarily
produce a different drug blood level than proprietary medications. Body fat is not measured
by drug blood levels. Drug blood levels only measure the amount of drug in the body; they do
not determine the source of the medication.
DIF: Cognitive Level: Comprehension REF: p. 17 OBJ: 3
NAT: NCLEX Client Needs Category: Physiological Integrity
TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Safety
6. What is the process by which a drug is transported by circulating body fluids to receptor sites?
a. Osmosis
b. Distribution
c. Absorption
d. Biotransformation
ANS: B
, Distribution refers to the ways in which drugs are transported by the circulating body fluids to
the sites of action (receptors), metabolism, and excretion. Osmosis is the process of moving
solution across a semipermeable membrane to equalize the dilution on each side. Absorption
is the process by which a drug is transferred from its site of entry into the body to the
circulating fluids for distribution. Biotransformation, also called metabolism, is the process by
which the body inactivates drugs.
DIF: Cognitive Level: Comprehension REF: p. 15 OBJ: 3
NAT: NCLEX Client Needs Category: Physiological Integrity
TOP: Nursing Process Step: Planning CON: Patient Education | Clinical Judgment | Safety
7. The nurse assesses which blood level to determine the amount of circulating medication in a
patient?
a. Peak
b. Trough
c. Drug
d. Therapeutic
ANS: C
When a drug is circulating in the blood, a blood sample may be drawn and assayed to
determine the amount of drug present; this is known as the drug blood level. Peak levels are
only those drug blood levels that are at their maximum before metabolism starts to decrease
the amount of circulating drug. Trough levels are only those drug blood levels that are at their
minimum when metabolism has decreased the amount of circulating drug and before an
increase caused by a subsequent dose of the medication. Therapeutic levels are only those
within a prescribed range of blood levels determined to bring about effective action of the
medication.
DIF: Cognitive Level: Comprehension REF: p. 17 OBJ: 3
NAT: NCLEX Client Needs Category: Physiological Integrity
TOP: Nursing Process Step: Evaluation CON: Patient Education | Clinical Judgment | Safety
8. The nurse administers 50 mg of a drug at 6:00 AM that has a half-life of 8 hours. What time
will it be when 25 mg of the drug has been eliminated from the body?
a. 8:00 AM
b. 11:00 AM
c. 2:00 PM
d. 6:00 PM
ANS: C
Fifty percent of the medication, or 25 mg, will be eliminated in 8 hours, or at 2:00 PM. 8:00
AM is 2 hours after administration; the half-life is 8 hours. 11:00 AM is 4 hours after
administration; the half-life is 8 hours. 6:00 PM is 12 hours after administration; the half-life
is 8 hours.
DIF: Cognitive Level: Analysis REF: p. 15 OBJ: 2
NAT: NCLEX Client Needs Category: Physiological Integrity
TOP: Nursing Process Step: Evaluation
CON: Clinical Judgment | Safety | Elimination | Health Promotion
9. What will the nurse need to determine first in order to mix two drugs in the same syringe?
Willihnganz: Clayton’s Basic Pharmacology for Nurses, 18th Edition
MULTIPLE CHOICE
1. The nurse assesses hives in a patient started on a new medication. What is the nurse’s priority
action?
a. Notify physician of allergic reaction.
b. Notify physician of idiosyncratic reaction.
c. Notify physician of potential teratogenicity.
d. Notify physician of potential tolerance.
ANS: A
An allergic reaction is indicative of hypersensitivity and manifests with hives and/or urticaria,
which are easily identified. An idiosyncratic reaction occurs when something unusual or
abnormal happens when a drug is first administered. A teratogenic reaction refers to the
occurrence of birth defects related to administration of the drug. Tolerance refers to the body’s
requirement for increasing dosages to achieve the same effects that a lower dose once did.
DIF: Cognitive Level: Application REF: p. 17 OBJ: 4
NAT: NCLEX Client Needs Category: Physiological Integrity
TOP: Nursing Process Step: Assessment CON: Clinical Judgment | Safety
2. The nurse administers an initial dose of a steroid to a patient with asthma. Thirty minutes after
administration, the nurse finds the patient agitated and stating that “everyone is out to get me.”
What is the term for this unusual reaction?
a. Desired action
b. Adverse effect
c. Idiosyncratic reaction
d. Allergic reaction
ANS: C
Idiosyncratic reactions are unusual, abnormal reactions that occur when a drug is first
administered. Patients typically exhibit an overresponsiveness to a medication related to
diminished metabolism. These reactions are believed to be related to genetic enzyme
deficiencies. Desired actions are expected responses to a medication. Adverse effects are
reactions that occur in another system of the body; they are usually predictable. Allergic
reactions appear after repeated medication dosages.
DIF: Cognitive Level: Knowledge REF: p. 18 OBJ: 4
NAT: NCLEX Client Needs Category: Physiological Integrity
TOP: Nursing Process Step: Evaluation
CON: Patient Education | Clinical Judgment | Caregiving | Safety | Sensory Perception
3. Which is the best description of when drug interactions occur?
a. On administration of toxic dosages of a drug
b. On an increase in the pharmacodynamics of bound drugs
c. On the alteration of the effect of one drug by another drug
d. On increase of drug excretion
ANS: C
, Drug interactions may be characterized by an increase or decrease in the effectiveness of one
or both of the drugs. Toxicity of one drug may or may not affect the metabolism of another
one. Drug interactions may result from either increased or decreased pharmacodynamics.
Drug interactions may result from either increased or decreased excretion.
DIF: Cognitive Level: Comprehension REF: p. 18 OBJ: 5
NAT: NCLEX Client Needs Category: Physiological Integrity
TOP: Nursing Process Step: Assessment CON: Safety | Patient Education | Clinical Judgment
4. What occurs when two drugs compete for the same receptor site, resulting in increased
activity of the first drug?
a. Desired action
b. Synergistic effect
c. Carcinogenicity
d. Displacement
ANS: D
The displacement of the first drug from receptor sites by a second drug increases the amount
of the first drug because more unbound drug is available. An expected response of a drug is
the desired action. A synergistic effect is the effect of two drugs being greater than the effect
of each chemical individually or the sum of the individual effects. Carcinogenicity is the
ability of a drug to cause cells to mutate and become cancerous.
DIF: Cognitive Level: Comprehension REF: p. 19 OBJ: 6
NAT: NCLEX Client Needs Category: Physiological Integrity
TOP: Nursing Process Step: Implementation CON: Safety | Patient Education
5. What do drug blood levels indicate?
a. They confirm if the patient is taking a generic form of a drug.
b. They determine if the patient has sufficient body fat to metabolize the drug.
c. They verify if the patient is taking someone else’s medications.
d. They determine if the amount of drug in the body is in a therapeutic range.
ANS: D
The amount of drug present may vary over time and the blood level must remain in a
therapeutic range in order to obtain the desired result. Generic drugs do not necessarily
produce a different drug blood level than proprietary medications. Body fat is not measured
by drug blood levels. Drug blood levels only measure the amount of drug in the body; they do
not determine the source of the medication.
DIF: Cognitive Level: Comprehension REF: p. 17 OBJ: 3
NAT: NCLEX Client Needs Category: Physiological Integrity
TOP: Nursing Process Step: Evaluation CON: Clinical Judgment | Safety
6. What is the process by which a drug is transported by circulating body fluids to receptor sites?
a. Osmosis
b. Distribution
c. Absorption
d. Biotransformation
ANS: B
, Distribution refers to the ways in which drugs are transported by the circulating body fluids to
the sites of action (receptors), metabolism, and excretion. Osmosis is the process of moving
solution across a semipermeable membrane to equalize the dilution on each side. Absorption
is the process by which a drug is transferred from its site of entry into the body to the
circulating fluids for distribution. Biotransformation, also called metabolism, is the process by
which the body inactivates drugs.
DIF: Cognitive Level: Comprehension REF: p. 15 OBJ: 3
NAT: NCLEX Client Needs Category: Physiological Integrity
TOP: Nursing Process Step: Planning CON: Patient Education | Clinical Judgment | Safety
7. The nurse assesses which blood level to determine the amount of circulating medication in a
patient?
a. Peak
b. Trough
c. Drug
d. Therapeutic
ANS: C
When a drug is circulating in the blood, a blood sample may be drawn and assayed to
determine the amount of drug present; this is known as the drug blood level. Peak levels are
only those drug blood levels that are at their maximum before metabolism starts to decrease
the amount of circulating drug. Trough levels are only those drug blood levels that are at their
minimum when metabolism has decreased the amount of circulating drug and before an
increase caused by a subsequent dose of the medication. Therapeutic levels are only those
within a prescribed range of blood levels determined to bring about effective action of the
medication.
DIF: Cognitive Level: Comprehension REF: p. 17 OBJ: 3
NAT: NCLEX Client Needs Category: Physiological Integrity
TOP: Nursing Process Step: Evaluation CON: Patient Education | Clinical Judgment | Safety
8. The nurse administers 50 mg of a drug at 6:00 AM that has a half-life of 8 hours. What time
will it be when 25 mg of the drug has been eliminated from the body?
a. 8:00 AM
b. 11:00 AM
c. 2:00 PM
d. 6:00 PM
ANS: C
Fifty percent of the medication, or 25 mg, will be eliminated in 8 hours, or at 2:00 PM. 8:00
AM is 2 hours after administration; the half-life is 8 hours. 11:00 AM is 4 hours after
administration; the half-life is 8 hours. 6:00 PM is 12 hours after administration; the half-life
is 8 hours.
DIF: Cognitive Level: Analysis REF: p. 15 OBJ: 2
NAT: NCLEX Client Needs Category: Physiological Integrity
TOP: Nursing Process Step: Evaluation
CON: Clinical Judgment | Safety | Elimination | Health Promotion
9. What will the nurse need to determine first in order to mix two drugs in the same syringe?
