Chapter 01: Orientation to Pharmacology

Burchum: Lehne’s Pharmacology for Nursing Care, 11th Edition

MULTIPLE CHOICE

1. The nurse is teaching a patient how a medication works to treat an illness. To do this, the nurse

will rely on knowledge of which topic?

a. Clinical pharmacology

b. Drug efficacy

c. Pharmacokinetics

d. Pharmacotherapeutics

ANS: D

Pharmacotherapeutics is the study of the use of drugs to diagnose, treat, and prevent conditions.

Clinical pharmacology is concerned with all aspects of drug-human interactions. Drug efficacy

measures the extent to which a given drug causes an intended effect. Pharmacokinetics is the

study of the impact of the body on a drug.

PTS: 1

2. What is a desired outcome when a drug is described as easy to administer?

a. It can be stored indefinitely without need for refrigeration.

b. It does not interact significantly with other medications.

c. It enhances patient adherence to the drug regimen.

d. It is usually relatively inexpensive to produce.

ANS: C

A major benefit of drugs that are easy to administer is that patients taking them are more likely to

comply with the drug regimen. Drugs that are easy to give may have the other attributes listed,

but those properties are independent of ease of administration.

PTS: 1

3. A patient tells the nurse that an analgesic he will begin taking may cause drowsiness and will

decrease pain up to 4 hours at a time. Based on this understanding of the drug’s effects by the

patient, the nurse will anticipate which outcome?

a. Decreased chance of having a placebo effect

b. Decreased motivation to take the drug

c. Improved compliance with the drug regimen

d. Increased likelihood of drug overdose

ANS: C

A drug is effective if it produces the intended effects, even if it also produces side effects.

Patients who understand both the risks and benefits of taking a medication are more likely to

comply with the drug regimen.

PTS: 1

MULTIPLE RESPONSE

1. What are considered the ‘Big Three’ properties of an ideal drug? (Select all that apply.)

a. Irreversible action

b. Effectiveness

c. Safety

d. Selectivity

e. A recognizable trade name

ANS: B, C, D

The ‘Big Three’ properties of the ideal drug are effectiveness, safety, and selectivity.

PTS: 1

2. Before administering a medication, what does the nurse need to know to evaluate how individual

patient variability might affect the patient’s response to the medication? (Select all that apply.)

a. Chemical stability of the medication

b. Ease of administration

c. Family medical history

d. Patient’s age

e. Patient’s diagnosis

ANS: C, D, E

The family medical history can indicate genetic factors that may affect a patient’s response to a

medication. Patients of different ages can respond differently to medications. The patient’s

illness can affect how drugs are metabolized. The chemical stability of the medication and the

ease of administration are properties of drugs.

PTS: 1

Chapter 02: Application of Pharmacology in Nursing Practice

Burchum: Lehne’s Pharmacology for Nursing Care, 11th Edition

MULTIPLE CHOICE

1. A patient is using a metered-dose inhaler containing albuterol for asthma. The medication label

instructs the patient to administer “2 puffs every 4 hours as needed for coughing or wheezing.”

The patient reports feeling jittery sometimes when taking the medication, and doesn’t feel that

the medication is always effective. Which action is outside the nurse’s scope of practice?

a. Asking the patient to demonstrate the use of the inhaler

b. Assessing the patient’s exposure to tobacco smoke

c. Auscultating lung sounds and obtaining vital signs

d. Suggesting that the patient use 1 puff to reduce side effects

ANS: D

It is not within the nurse’s scope of practice to change the dose of a medication without an order

from a prescriber. Asking the patient to demonstrate inhaler use helps the nurse to evaluate the

patient’s ability to administer the medication properly and is part of the nurse’s evaluation.

Assessing tobacco smoke exposure helps the nurse determine whether nondrug therapies, such a

smoke avoidance, can be used as an adjunct to drug therapy. Performing a physical assessment

helps the nurse evaluate the patient’s response to the medication.

PTS: 1

2. A postoperative patient is being discharged home with acetaminophen/hydrocodone [Norco] for

pain. The patient asks the nurse about using Tylenol for fever. Which statement by the nurse is

correct?

a. “It is not safe to take over-the-counter drugs with prescription medications.”

b. “Taking the two medications together poses a risk of drug toxicity.”

c. “There are no known drug interactions, so this will be safe.”

d. “Tylenol and Norco are different drugs, so there is no risk of overdose.”

ANS: B

Tylenol is the trade name and acetaminophen is the generic name for the same medication. It is

important to teach patients to be aware of the different names for the same drug to minimize the

risk of overdose. Over-the-counter (OTC) medications and prescription medications may be

taken together unless significant harmful drug interactions are possible. Even though no drug

interactions are at play in this case, both drugs contain acetaminophen, which could lead to

toxicity.

PTS: 1

3. The nurse is preparing to care for a patient who will be taking an antihypertensive medication.

Which action by the nurse is part of the assessment step of the nursing process?

a. Asking the prescriber for an order to monitor serum drug levels

b. Monitoring the patient for drug interactions after giving the medication

c. Questioning the patient about over-the-counter medications

d. Taking the patient’s blood pressure throughout the course of treatment

ANS: C

The assessment part of the nursing process involves gathering information before beginning

treatment, and this includes asking about other medications the patient may be taking.

Monitoring serum drug levels, watching for drug interactions, and checking vital signs after

giving the medication are all part of the evaluation phase.

PTS: 1

4. A postoperative patient reports pain, which the patient rates as an 8 on a scale from 1 to 10 (10

being the most extreme pain). The prescriber has ordered acetaminophen [Tylenol] 650 mg PO

every 6 hours PRN pain. What will the nurse do?

a. Ask the patient what medications have helped with pain in the past.

b. Contact the provider to request a different analgesic medication.

c. Give the pain medication and reposition the patient to promote comfort.

d. Request an order to administer the medication every 4 hours.

ANS: B

The nursing diagnosis for this patient is severe pain. Acetaminophen is given for mild to

moderate pain, so the nurse should ask the prescriber to order a stronger analgesic medication.

Asking the patient to tell the nurse what has helped in the past is part of an initial assessment and

should be done preoperatively and not when the patient is having severe pain. Because the

patient is having severe pain, acetaminophen combined with nondrug therapies will not be

sufficient. Increasing the frequency of the dose of a medication for mild pain will not be

effective.

PTS: 1

5. A patient newly diagnosed with diabetes is to be discharged from the hospital. The nurse

teaching this patient about home management should begin by doing what?

a. Asking the patient to demonstrate how to measure and administer insulin

b. Discussing methods of storing insulin and discarding syringes

c. Giving information about how diet and exercise affect insulin requirements

d. Teaching the patient about the long-term consequences of poor diabetes control

ANS: A

Because insulin must be given correctly to control symptoms and because an overdose can be

fatal, it is most important for the patient to know how to administer it. Asking for a

demonstration of technique is the best way to determine whether the patient has understood the

teaching. When a patient is receiving a lot of new information, the information presented first is

the most likely to be remembered. The other teaching points are important as well, but they are

not as critical and can be taught later.

PTS: 1

6. The nurse receives an order to give morphine 5 mg IV every 2 hours PRN pain. Which action is

not part of the six rights of drug administration?

a. Assessing the patient’s pain level 15 to 30 minutes after giving the medication

b. Checking the medication administration record to see when the last dose was

administered

c. Consulting a drug manual to determine whether the amount the prescriber ordered

is appropriate

d. Documenting the reason the medication was given in the patient’s electronic

medical record

ANS: A

Assessing the patient’s pain after administering the medication is an important part of the nursing

process when giving medications, but it is not part of the six rights of drug administration.

Checking to see when the last dose was given helps ensure that the medication is given at the

right time. Consulting a drug manual helps ensure that the medication is given in the right dose.

Documenting the reason for a pain medication is an important part of the right documentation—

the sixth right.

PTS: 1

7. A patient tells a nurse that a medication prescribed for recurrent migraine headaches is not

working. What will the nurse do?

a. Ask the patient about the number and frequency of tablets taken.

b. Assess the patient’s headache pain on a scale from 1 to 10.

c. Report the patient’s complaint to the prescriber.

d. Suggest biofeedback as an adjunct to drug therapy.

ANS: A

When evaluating the effectiveness of a drug, it is important to determine whether the patient is

using the drug as ordered. Asking the patient to tell the nurse how many tablets are taken and

how often helps the nurse determine compliance. Assessing current pain does not yield

information about how well the medication is working unless the patient is currently taking it.

The nurse should gather as much information about compliance, symptoms, and drug

effectiveness as possible before contacting the prescriber. Biofeedback may be an effective

adjunct to treatment, but it should not be recommended without complete information about drug

effectiveness.

PTS: 1

8. A nurse is preparing to administer medications. Which patient would the nurse consider to have

the greatest predisposition to an adverse reaction?

a. A 30-year-old man with kidney disease

b. A 75-year-old woman with cystitis

c. A 50-year-old man with an upper respiratory tract infection

d. A 9-year-old boy with an ear infection

ANS: A

The individual with impaired kidney function would be at risk of having the drug accumulate to

a toxic level because of potential excretion difficulties. Cystitis is an infection of the bladder and

not usually the cause of excretion problems that might lead to an adverse reaction from a

medication. A respiratory tract infection would not predispose a patient to an adverse reaction,

because drugs are not metabolized or excreted by the lungs. A 9-year-old boy would not have the

greatest predisposition to an adverse reaction simply because he is a child; nor does an ear

infection put him at greater risk.

PTS: 1

9. A nurse consults a drug manual before giving a medication to an 80-year-old patient. The manual

states that older adult patients are at increased risk for hepatic side effects. Which action by the

nurse is correct?

a. Contact the provider to discuss an order for pretreatment laboratory work.

b. Ensure that the drug is given in the correct dose at the correct time to minimize the

risk of adverse effects.

c. Notify the provider that this drug is contraindicated for this patient.

d. Request an order to give the medication intravenously so that the drug does not

pass through the liver.

ANS: A

The drug manual indicates that this drug should be given with caution to elderly patients. Getting

information about liver function before giving the drug establishes baseline data that can be

compared with post-treatment data to determine whether the drug is affecting the liver. Giving

the correct dose at the correct interval helps to minimize risk, but without baseline information,

the effects cannot be determined. The drug is not contraindicated.

PTS: 1

10. A patient has been receiving intravenous penicillin for pneumonia for several days and begins to

complain of generalized itching. The nurse auscultates bilateral wheezing and notes a

temperature of 38.5°C (101°F). Which is the correct action by the nurse?

a. Administer the next dose and continue to evaluate the patient’s symptoms.

b. Ask the prescriber if an antihistamine can be given to relieve the itching.

c. Contact the prescriber to request an order for a chest radiograph.

d. Hold the next dose and notify the prescriber of the symptoms.

ANS: D

Pruritus and wheezing are signs of a possible allergic reaction, which can be fatal; therefore, the

medication should not be given and the prescriber should be notified. When patients are having a

potentially serious reaction to a medication, the nurse should not continue giving the medication.

Antihistamines may help the symptoms of an allergic reaction, but the first priority is to stop the

medication. Obtaining a chest radiograph is not helpful.