Deck 3: Pharmacokinetics, Pharmacodynamics, and Pharmacogenetics

Question 1

A patient who is newly diagnosed with type 1 diabetes mellitus asks why insulin must be given by subcutaneous injection instead of by mouth. The nurse will explain that this is because

A) absorption is diminished by the first-pass effects in the liver.
B) absorption is faster when insulin is given subcutaneously.
C) digestive enzymes in the GI tract break down the drug and prevent absorption.
D) the oral form is less predictable with more adverse effects.

Answer 1

digestive enzymes in the GI tract break down the drug and prevent absorption.

Question 2

The nurse is preparing to administer the first dose of digoxin (Lanoxin) to a patient and notes that the initial dose ordered is much higher than the ordered maintenance dose. Which of the following describes why the first dose is higher?

A) Digoxin requires a loading dose.
B) Digoxin undergoes first-pass metabolism when initially administered.
C) Digoxin has a long duration of action.
D) Digoxin has a short half-life.

Answer 2

Digoxin requires a loading dose.

Question 3

The nurse gives a highly metabolized medication to a patient with a history of liver disease. The nurse will monitor this patient for:

A) decreased drug effects.
B) increased drug effects.
C) decreased therapeutic range.
D) increased therapeutic range.

Answer 3

increased drug effects.

Question 4

A patient has been taking a drug that is 75% protein-Bound. The provider adds a new medication that is 90% protein-bound. The nurse will expect a potential:

A) decreased drug effects of the first drug.
B) decreased therapeutic range of the first drug.
C) increased drug effects of the first drug.
D) increased therapeutic range of the first drug.

Question 5

The nurse administers albuterol to a patient who has asthma. The albuterol acts by stimulating beta₂-adrenergic receptors to cause bronchodilation. The nurse understands that albuterol is a beta-adrenergic:

A) agonist.
B) antagonist.
C) inhibitor.
D) depressant.

Question 6

The nurse is caring for a patient who has taken an overdose of aspirin several hours prior. The provider orders sodium bicarbonate to be given. The nurse understands that this drug is given for which purpose?

A) To counter the toxic effects of the aspirin
B) To decrease the half-life of the aspirin
C) To increase the excretion of the aspirin
D) To neutralize the acid of the aspirin

Question 7

The nurse is preparing to administer an oral medication and wants to ensure a rapid drug action. Which form of the medication will the nurse prefer to administer?

A) Capsule
B) Enteric-coated pill
C) Liquid suspension
D) Tablet

Question 8

The nurse gives 800 mg of a drug that has a half-life of 8 hours. How much drug will be left in the body in 24 hours if no additional drug is given?

A) None
B) 50 mg
C) 100 mg
D) 200 mg

Question 9

Which drug will go through a disintegration process after it is administered?

A) Intramuscular (IM) cephalosporins
B) Intravenous (IV) vasopressors
C) Oral analgesics
D) Subcutaneous insulin

Question 10

The nurse is preparing an injectable drug and wants to administer it for the most rapid absorption as possible. How will the nurse give this medication?

A) IM into the deltoid muscle
B) IM into the gluteal muscle
C) Subcut into abdominal tissue
D) Subcut into the upper arm

Question 11

The nurse is preparing to administer a drug that is ordered to be given twice daily. The nurse reviews the medication information and learns that the drug has a half-life of 24 hours. What will the nurse do next?

A) Administer the medication as ordered
B) Contact the provider to discuss daily dosing
C) Discuss every-other-day dosing with the provider
D) Hold the medication

Question 12

The nurse is preparing to administer an oral medication that is water soluble. The nurse understands that this drug:

A) must be taken on an empty stomach.
B) requires active transport for absorption.
C) should be taken with fatty foods.
D) will readily diffuse into the GI tract.

Question 13

The nurse is reviewing medication information with a nursing student prior to administering an oral drug and notes that the drug has extensive first-pass effects. Which statement by the student indicates an understanding of the first-ass effect?

A) "The first-pass effect means the drug has 100% bioavailability."
B) "The first-pass effect means the drug is absorbed from the GI tract into the portal vein where it is transported to the liver and metabolized."
C) "The first-pass effect means the drug was given by injection and immediately metabolized."
D) "The first-pass effect means the drug may be unchanged as it passes through the liver."

Question 14

The nurse prepares to change a patient's medication from an IV to an oral form and notes that the oral form is ordered in a higher dose. The nurse understands that this is due to differences in:

A) bioavailability.
B) pinocytosis.
C) protein binding.
D) tachyphylaxis.

Question 15

The nurse is preparing to administer a drug that is eliminated through the kidneys. The nurse reviews the patient's chart and notes that the patient has increased serum creatinine and blood urea nitrogen (BUN). The nurse will perform which action?

A) Administer the drug as ordered.
B) Anticipate a shorter than usual half-life of the drug.
C) Expect decreased drug effects when the drug is given.
D) Verify that the dose ordered is appropriate based on the patient's kidney function.

Question 16

The nurse understands that the length of time needed for a drug to reach the minimum effective concentration (MEC) is the

A) duration of action.
B) onset of action.
C) peak action time.
D) time response curve.

Question 17

The nurse is preparing to administer a drug and learns that it is 90% protein bound. The patient's serum albumin level is low. The nurse will observe the patient for:

A) decreased drug absorption.
B) decreased drug interactions.
C) decreased drug toxicity.
D) increased drug effects.

Question 18

The nurse is teaching a patient who will be discharged home with a prescription for an enteric-coated tablet. Which statement by the patient indicates understanding of the teaching?

A) "I may crush the tablet and put it in applesauce to improve absorption."
B) "I should consume acidic foods to enhance absorption of this medication."
C) "I should expect a delay in onset of the drug's effects after taking the tablet."
D) "I should take this medication with high-fat foods to improve its action."

Question 19

If a drug has a half-life of 12 hours and is given twice daily starting at 0800 on a Monday, when will a steady state be achieved?

A) 0800 on Tuesday
B) 0800 on Wednesday
C) 0800 on Thursday
D) 0800 on Friday

Question 20

The nurse is administering two drugs to a patient and learns that both drugs are highly protein-bound. The nurse may expect

A) decreased bioavailability of both drugs.
B) decreased drug effects.
C) decreased drug interactions.
D) increased risk of adverse effects.

Question 21

A patient asks the nurse about using OTC medications. The nurse will tell the patient that OTC medications:

A) are not as effective as prescription medications.
B) are not as safe as prescription medications.
C) have fewer side effects and drug interactions than prescription medications.
D) should be included when listing any medications taken by the patient.

Question 22

A patient is taking phenytoin to prevent seizures. The nurse knows that phenytoin is highly protein-bound and has sedating effects. The nurse reviews the patient's chart and notes a low serum albumin. The nurse will notify the provider and observe the patient for which effects?

A) Decreased sedative effects
B) Increased sedative effects
C) Increased seizures
D) No change in effects

Question 23

A patient has been taking a drug for several years and tells the nurse it is no longer working. The nurse learns that the patient has recently begun taking an over-the-counter (OTC) antacid medication. What does the nurse suspect is occurring?

A) An adverse drug reaction
B) A drug interaction
C) Drug incompatibility
D) Drug tolerance

Question 24

The nurse is preparing to administer two IV medications that should not be given using the same IV tubing. The nurse understands that this is because of drug:

A) adverse reactions.
B) incompatibility.
C) interactions.
D) potentiation.

Question 25

The nurse assesses a patient who is receiving morphine sulfate intravenously using a patient-controlled analgesia pump. The nurse notes somnolence and respiratory depression, which are signs of morphine toxicity. The nurse will prepare to administer naloxone (Narcan) because it:

A) has synergistic effects with morphine.
B) is a narcotic agonist.
C) is a narcotic antagonist.
D) potentiates narcotic effects.

Question 26

The nurse is caring for a patient who receives theophylline, which has a narrow therapeutic index. The patient has been receiving cimetidine but will stop taking that drug in 2 days. In 2 days, the nurse will observe the patient closely for:

A) decreased effectiveness of theophylline.
B) increased effectiveness of theophylline.
C) decreased toxicity of theophylline.
D) prolonged effectiveness of theophylline.

Question 27

A patient will receive penicillin to treat an infection. The provider orders probenecid (Probalan), a medication to treat gout, even though the patient does not have gout. Which action by the nurse is correct?

A) Administer the drug since the provider ordered it.
B) Recognize that it is being given prophylactically.
C) Refuse to administer the medication since it is not indicated.
D) Verify that it is being given for its secondary action.

Question 28

The nurse is teaching a patient about taking a once-daily medication that has a side effect of drowsiness. The nurse learns that the patient works a 7:00 PM to 7:00 AM shift in a hospital. The nurse will recommend that the patient take this medication at which time of day?

A) 0600
B) 0800
C) 1800
D) 2000

Question 29

The nurse is preparing to administer furosemide to a patient who takes digoxin. The nurse will plan to monitor the patient for:

A) digoxin toxicity.
B) decreased digoxin effects.
C) furosemide toxicity.
D) decreased furosemide effects.

Question 30

The nurse is teaching a patient about a drug that causes photosensitivity. Which statement by the patient indicates a need for further teaching?

A) "I should apply sunscreen with a sun protection factor greater than 15."
B) "I should avoid sunlight when possible while taking this drug."
C) "I will wear protective clothing when I am outdoors."
D) "I will wear sunglasses even while I am indoors."

Question 31

The nurse is teaching a patient who will begin taking ciprofloxacin. What instruction will the nurse include when teaching this patient about this drug?

A) "Do not take this medication with oral contraceptive pills."
B) "Take at least 1 hour after or 2 hours before taking antacids."
C) "Take in the morning with your multivitamin tablet."
D) "Take with milk to reduce gastric upset."

Question 32

A patient calls the clinic and tells the nurse that a newly prescribed medication isn't working. What is the nurse's next action?

A) Notify the provider and discuss increasing the dose.
B) Question the patient about compliance with the regimen.
C) Review the drug information with the patient.
D) Suggest the patient discuss changing medications with the provider.

Question 33

A patient has been taking warfarin (Coumadin), which is highly protein-bound. The patient will begin taking gemfibrozil, which is also highly protein-bound. The nurse will observe the patient closely for:

A) decreased effects of warfarin.
B) increased effects of warfarin.
C) decreased effects of gemfibrozil.
D) decreased effects of both drugs.

Question 34

The nurse is preparing to teach a patient who will begin taking a monoamine oxidase (MAO) inhibitor. What is most important when teaching patients about MAO inhibitors?

A) Emphasizing the importance of potassium intake
B) Giving detailed drug information
C) Reviewing dietary guidelines
D) Providing a schedule for medication administration

Question 35

A patient who takes the anticoagulant warfarin will begin taking the anticonvulsant drug carbamazepine. The nurse reviews the drug information for these drugs and learns that carbamazepine is a hepatic enzyme inducer. The nurse anticipates that which of the following may be required?

A) Decrease the dose of carbamazepine
B) Increase the dose of carbamazepine
C) Decrease the dose of warfarin
D) Increase the dose of warfarin

Question 36

The community health nurse is teaching a group of elderly residents in an assisted care facility about medication use. The nurse will remind the residents that OTC medications:

A) are not as effective as prescription medications.
B) are not recommended for older adults.
C) are safer than prescription medications.
D) should be reviewed with a provider before taking.

Question 37

The nurse administers a centrally acting analgesic to a patient who has been receiving it for 1 day after orthopedic surgery with successful pain relief. The patient reports no change in pain 30 minutes after the medication is given. The nurse recognizes that this patient is likely exhibiting:

A) drug-seeking behavior.
B) drug tolerance.
C) the placebo effect.
D) tachyphylaxis.

Question 38

The provider has ordered amoxicillin with clavulanate (Augmentin) for a child who has otitis media. The child's parent asks why this drug is necessary when amoxicillin is less expensive. The nurse will explain that clavulanate is added to amoxicillin because it:

A) binds with albumin to increase the amount of available amoxicillin.
B) broadens the spectrum of amoxicillin by inhibiting bacterial enzymes.
C) inhibits hepatic blood flow, leading to increased serum drug levels of amoxicillin.
D) inhibits the excretion of amoxicillin by interfering with renal function.

Question 39

A young adult female patient who takes a combination oral contraceptive (OCP) will begin taking an antibiotic. When teaching the patient about this medication, the nurse will while taking the antibiotic:

A) recommend using a backup method of contraception.
B) suggest that she switch to an injectable form of contraception.
C) tell her that the antibiotic is less effective if she is taking OCPs.
D) tell her the antibiotic has a greater risk for toxicity while taking OCPs.

Question 40

A patient who takes a drug that undergoes gastric absorption will begin taking an opioid analgesic after sustaining an injury in a motor vehicle accident. The nurse will observe the patient closely for which effects?

A) Decreased effects of the first drug
B) Increased effects of the first drug
C) Decreased effects of the narcotic
D) Increased effects of the narcotic

Question 41

Which patients are at particularly high risk for drug interactions? (Select all that apply.)

A) Patients who are acutely ill
B) Patients who are taking multiple medications
C) Patients who see several specialists
D) Patients who take supplements and OTC medications
E) Patients who use one pharmacy for several medications