answer key

Answer KeyQuestion 1:(see full question)

A nurse is explaining to a patient about the need to administer a loading dose of a drug. Which of the following statements best reflects the reason for administering the loading dose?

You selected: "We want to make sure that the drug becomes effective faster."

Correct

Explanation: A loading dose is recommended for use with drugs that may take a prolonged period to reach critical concentration so that the effects can be obtained more quickly. Size is unrelated to the use of a loading dose. Evaluating the body's response is not an indication for using a loading dose. Duration of action is not an indication for using a loading dose. (less)

Reference: Aschenbrenner, D.S., & Venable, S.J. Drug Therapy in Nursing, 4th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2012, Chapter 4, Pharmacotherapeutics, Pharmacokinetics, and Pharmacodynamics, pp. 54-55.

Question 2:(see full question)

A patient is receiving 250 mg of a drug that has a half-life of 12 hours. How much drug would remain after 36 hours?

You selected: 31.25 mg

Correct

Explanation: This amount of drug is present after 36 hours. This amount of drug would be present after 12 hours. This amount of drug would be present after 24 hours. This amount of drug would b... (more)

Reference: Aschenbrenner, D.S., & Venable, S.J. Drug Therapy in Nursing, 4th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2012, Chapter 4, Pharmacotherapeutics, Pharmacokinetics, and Pharmacodynamics, p. 51.


When a drug is discontinued, what percentage of that drug will remain in the body after three half-lives?

You selected: 25%

Incorrect

Correct response: 12.5%

Explanation: Each half-life removes 50% of the drug stored in the body.

Hence, after one half-life, the percentage of drug in the body would be 50%. After two half-lives, the percentage of drug in the body would be half of 50%, which is 25%. Consequently, after three half-lives, the percentage of drug would be 12.5%. (less)

Reference: Aschenbrenner, D.S., & Venable, S.J. Drug Therapy in Nursing, 4th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2012, Chapter 4: Pharmacotherapeutics, Pharmacokinetics, and Pharmacodynamics, p. 51.


Your patient is taking low dose aspirin daily for their heart. You know that the patient is not receiving all the dosage of the aspirin that is being ingested. This occurs because of what?

You selected: Liver metabolism

Incorrect

Correct response: First-pass effect

Explanation: A large percentage of an oral dose is destroyed when it reaches the liver and never reaches the tissues. This phenomenon is known as the first-pass effect. Therefore Options A, C, ... (more)



The nursing students are learning about the half-life of drugs. A student asks the instructor to explain half-life. What would be the instructor's best response?

You selected: Half-life of a drug is the time it takes for the drug to reach ½ of its' potential peak level in the body.

Incorrect

Correct response: Half-life of a drug is the time it takes for the amount of drug in the body to decrease to one-half of the peak level it previously achieved.

Explanation: The half-life of a drug is the time it takes for the amount of drug in the body to decrease to one-half of the peak level it previously achieved. Therefore Options B, C, and D are ... (more)



Drugs do not metabolize the same in all people. In which of the following patients would a nurse expect to see an alteration in drug metabolism?

You selected: A 50-year-old male with cirrhosis of the liver

Correct

Explanation: The liver is the most important site of drug metabolism. If the liver is not functioning effectively like in patients with cirrhosis, drugs will not be metabolized normally and tox... (more)



The nurse is explaining the pharmacokinetics of a drug being administered to a client. What is meant by the term "pharmakokinetics?"

You selected: Actions of drugs

Correct

Explanation: Pharmacokinetics refers to the actions of drugs. The route of administration refers to the route or method by which a medication is administered. Treatment of overdoses and dosages... (more)



The nurse is preparing to administer a prescribed drug to a patient with a history of renal disease. The nurse expects a reduction in dosage based on the understanding that which of the following might be altered?

You selected: Metabolism

Incorrect

Correct response: Excretion

Explanation: If the kidneys are not functioning properly, a drug may not be excreted properly and could accumulate in the body. Metabolism may be altered if the patient has liver disease.... (more)



Urine acidity can play an important role in drug excretion.

You selected: True

Correct



The patient is a six-year-old who is taking 125 mg of Amoxicillin every 6 hours. Assuming that the half-life of Amoxicillin is 3 hours, how much Amoxicillin would be in the child's body at the time of the next administration of the drug?

You selected: 31.25 mg

Correct

Explanation: The half-life of a drug is the time it takes for the amount of drug in the body to decrease to one-half of the peak level it previously achieved. Option A would occur at 3 hours af... (more)



When drugs are bound to proteins in the blood they can be transported to different areas of the body. The protein-drug

complex is relatively large and cannot enter into capillaries and into tissues to react. What must occur for drugs to do their job in the body?

You selected: The drug must be freed from the protein binding site

Correct

Explanation: Most drugs are bound to some extent to proteins in the blood to be carried into circulation. The protein–drug complex is relatively large and cannot ente... (more)



Drugs that are highly lipid soluble are more likely to pass through the blood-brain barrier and reach the central nervous system.

You selected: True

Correct



Only drugs that are lipid soluble or have a transport system have the ability to:

You selected: Cross the blood-brain barrier.

Correct

Explanation: The blood-brain barrier is composed of tight walls, limiting movement of drug molecules. This barrier makes drug therapy for the CNS difficult because drug molecules cannot pass th... (more)



A pharmacology student asks the instructor what an

accurate description of a drug agonist is. What would be the instructor's best response?

You selected: A drug that interacts directly with receptor sites to cause the same activity that a natural chemical would cause at that site

Correct

Explanation: Agonists are drugs that produce effects similar to those produced by naturally occurring neurotransmitters, hormones, or other substances found in the body. Non-competitive antago... (more)



A client older than 65 years is more likely to experience drug reaction than a client younger than 50 years. Which of the following factors accounts for this developmental variation?

You selected: Age-related physiologic changes

Correct

Explanation: In older adults (65 years and older), physiologic changes may alter all pharmacokinetic processes. Although drugs crossing the blood–brain barrier affect drug reaction, this ... (more)

Reference: Aschenbrenner, D.S., & Venable, S.J. Drug Therapy in Nursing, 4th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2012, Chapter 4, Pharmacotherapeutics, Pharmacokinetics, and Pharmcodynamics, p. 47.


Which of the following represents a pharmacokinetic phase? Select all that apply.

You selected: • Metabolism• Excretion• Distribution• Absorption

Correct

Explanation: The pharmacokinetic phases are absorption, distribution, metabolism, and excretion. The acronym A.D.M.E. is a

helpful way to remember to pharmacokinetic phases.... (more)



A nurse is to administer a drug that is loosely bound to protein. The nurse understands that this would mean which of the following?

You selected: The drug will lead to toxicity with other drugs.

Incorrect

Correct response: The drug will have a short duration of action.

Explanation: Drugs that are loosely bound to protein act very quickly and are excreted very quickly. Drugs that are tightly bound to protein are released very slowly. Drugs that are tightly bou... (more)



Pharmacotherapeutics is the achievement of the desired therapeutic goal of drug therapy. What standard does the FDA apply to a drug for approval?

You selected: The drug has to be statistically significantly more effective than placebo.

Correct

Explanation: If the clinical studies indicate that the effect a drug has on the desired treatment outcome is statistically significantly better than that achieved with a placebo (an inactive su... (more)



A drug with a half-life of 4 hours is administered at a dosage of 100 mg. How much of the drug will be in the patient's system 8 hours after administration?

You selected: 25 mg

Correct

Explanation: The half-life of a drug is the time it takes for the amount of drug in the body to decrease to one-half of the peak level it previously achieved. Option A would occur 2 hours after... (more)



The route medication must be given to achieve 100% bioavailability is given:

You selected: IV.

Correct

Explanation: Drugs given via the oral route, IM, and sub q routes are virtually always less than 100% available because some of the drug is absorbed in the GI or liver before reaching systemic ... (more)


Answer KeyQuestion 1: What does the lipid solubility of the drug influence?

(see full question)

You selected: Absorption of the drug

Incorrect

Correct response: Distribution of the drug

Explanation: As with absorption, factors that can affect distribution include the drug's lipid solubility and ionization and the perfusion of the reactive tissue. The lipid solubility of a drug... (more)



Which of the following is a key process with drug excretion?

You selected: Active transport

Correct

Explanation: Although active transport may be involved with absorption, it is a very important process in drug excretion in the kidney. Passive diffusion is the major process through which drug... (more)



What types of medication can pass through the blood–brain barrier or the placenta? (Select all that apply.)

You selected: • Water-soluble medications• Ionized medications• Lipophilic medications• Medications unbound to protein

Incorrect

Correct response: • Water-soluble medications• Lipophilic medications• Medications unbound to protein

Explanation: The blood–brain barrier and the placental barrier are protective mechanisms in the body that protect the brain or fetus from toxins. In order for a medication to pass throug...

(more)



Which factors will decrease the rate of drug absorption? Select all that apply.

You selected: • A disease that alters the stomach and small intestine lining

Incorrect

Correct response: • Higher drug concentration in the circulatory system• Drug given by a subcutaneous route versus an intramuscular route• A disease that alters the stomach and small intestine lining

Explanation: Increased blood flow will increase the rate of absorption, but if there is a higher concentration of the drug already in the blood, then the drug will not be absorbed as quickly. D... (more)



Which drug would most likely induce the effects of the cytochrome P450 enzyme system?

You selected: Ketoconazole

Incorrect

Correct response: Nicotine

Explanation: Nicotine, alcohol, and glucorticoids such as cortisone induce the effects of the P450 enzyme system. Ketoconazole, quinidine, and mexilitene inhibit the effects.... (more)

Reference: Aschenbrenner, D.S., & Venable, S.J. Drug Therapy in Nursing, 4th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2012, Chapter 4: Pharmacotherapeutics, Pharmacokinetics,

Pharmacodynamics, p. 47. Karch, A.M. Focus on Nursing Pharmacology, 5th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2011, Chapter 2: Drugs and the Body, p. 48.


A method that describes the process of absorption, distribution, and elimination of a drug in the body is known as:

You selected: Pharmacokinetics.

Correct

Explanation: Route of administration is the way in which the drug is introduced. Systemic drug effects are effects on body cells distant from the site of administration. Drug distribution invol... (more)



A patient presents to the emergency department with a drug level of 50 units/mL. The half-life of this drug is 1 hour. With this drug, concentrations above 25 units/mL are considered toxic and no more drug is given. How long will it take for the blood level to reach the non-toxic range?

You selected: 1 hour

Correct

Explanation: Half-life is the time required for the serum concentration of a drug to decrease by 50%. After 1 hour, the serum concentration would be 25 units/mL (50/2). After 2 hours the serum ... (more)



Fluoxitine is given to your patient at a dosage of 500 mg every 6 hours. Assuming that the half-life of this drug is 3 hours at what point would the drug level in the body be 62.5 mg of the original dose?

You selected: 9 hours after the original dose

Correct

Explanation: The half-life of a drug is the time it takes for the amount of drug in the body to decrease to one-half of the peak level it previously achieved. At a dose of 500 mg Option A would... (more)



A nurse is administering digoxin to one of their patients. When administering a drug the nurse needs to consider the phases of what so that the drug they are administering can be made as effective as possible?

You selected: Pharmacotherapeutics

Incorrect

Correct response: Pharmacokinetics

Explanation: When administering a drug, the nurse needs to consider the phases of pharmacokinetics so that the drug regimen can be made as effective as possible. Pharmacogenomics is the area of... (more)



The patient has a diagnosis of Multiple Sclerosis and is taking the beta seron drug Rebiff. The patient takes this drug by sub-q injection 3 times a week. The dosage is 44 mcg per injection. If the patient takes an injection on Monday, how much of the drug would still be in the patient's system when they take their next injection on Wednesday assuming the half-life of the drug is 24 hours?

You selected: 11 mcg

Correct

Explanation: The half-life of a drug is the time it takes for the amount of drug in the body to decrease to one-half of the peak level it previously achieved. Option A would occur 24 hours afte...

(more)



Drugs are chemicals that alter basic processes in body cells. That means that:

You selected: Drugs can stimulate or inhibit normal cellular functions; they cannot add functions.

Correct

Explanation: Dosage form is a consideration in effectiveness but not a major factor. Drugs are given for systemic effects, and therapeutic levels are dependant upon multiple factors.... (more)



Which drug would be considered an agonist?

You selected: Insulin

Correct

Explanation: Insulin is considered an agonist because it reacts with specific receptor sites to change the cell membrane permeability, interacting directly with the receptor sites to cause the ... (more)

Reference: Aschenbrenner, D.S., & Venable, S.J. Drug Therapy in Nursing, 4th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2012, Chapter 4: Pharmacotherapeutics, Pharmacokinetics, Pharmacodynamics, p. 47. Karch, A.M. Focus on Nursing Pharmacology, 5th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2011, Chapter 2: Drugs and the Body, p. 53.

Question 13: A nurse is caring for a patient who has been receiving a

(see full question) drug by the intramuscular (IM) route. The physician writes discharge orders, which include an order for the drug to be given orally. The nurse notices that the oral dosage is considerably higher than the parenteral dose. What does the nurse understand this is due to?

You selected: First-pass effect

Correct

Explanation: The first-pass effect involves drugs that are absorbed from the small intestine directly into the portal venous system, which delivers the drug molecules to the liver. Once in the... (more)



What influences drug absorption?

You selected: Route of administration

Correct

Explanation: Drug absorption is influenced by the route of administration. Some drugs are not taken with fluid, e.g., parenteral drugs, therefore Option A is incorrect. The route of excretion d... (more)



There are many enzyme systems in the body. What is disrupted if a single step in any enzyme system is blocked?

You selected: Cell function

Correct

Explanation: If a single step in one of the many enzyme systems is blocked, normal cell function is disrupted. Therefore Options A, B, and C are incorrect.... (more)

Reference: Aschenbrenner, D.S., & Venable, S.J. Drug Therapy in Nursing, 4th ed., Philadelphia: Wolters Kluwer

Health/Lippincott Williams & Wilkins, 2012, Chapter 4, Pharmacotherapeutics, Pharmacokinetics, and Pharmacodynamics, pp. 48-49.


A nurse would expect a drug to take the longest to be absorbed if given by which route?

You selected: Oral

Correct

Explanation: Generally, drugs given by the oral route are absorbed more slowly than those given parenterally. Generally, parenterally administered drugs are absorbed more quickly than oral drug... (more)



You are caring for a patient who is receiving Gentamycin, 250 mg and Diflucan, 500 mg at the same time. As the nurse you would know that if these two drugs competed with each other for protein binding sites what would this do?

You selected: Alter the effectiveness of the drugs

Correct

Explanation: Some drugs compete with each other for protein binding sites, altering effectiveness or causing toxicity when the two drugs are given together. Nothing in the scenario would indica... (more)



Most oral drugs are best taken on an empty stomach.

You selected: False

Incorrect

Correct response: True

Reference: Aschenbrenner, D.S., & Venable, S.J. Drug Therapy in Nursing, 4th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2012, Chapter 4, Pharmacotherapeutics, Pharmacokinetics, and Pharmacodynamics, pp. 43, 44.


One function of metabolism is to:

You selected: Increase the rate of metabolism for endogenous steroidal hormones.

Incorrect

Correct response: Convert fat-soluble drugs into water-soluble metabolites.

Explanation: Most drugs are lipid soluble, which aids movement across cell membranes; however, kidneys can only excrete water-soluble substances. Therefore, metabolism of the drug includes conv... (more)



A patient who is 6 feet tall and weighs 280 pounds will require which of the following doses?

You selected: Higher dose than a patient who weighs 180 pounds

Correct

Explanation: In general, people heavier than average may need larger doses, provided their renal, hepatic, and cardiovascular functions are adequate.... (more)



Which of the following is true of the hormone vasopressin? Select all that apply:

You selected: • Vasopressin regulates the reabsorption of water from the

kidney.• Vasopressin is secreted when body fluids must be conserved.

Correct

Explanation: The following is true of the hormone vasopressin: is secreted by the posterior pituitary gland, is secreted when body fluids must be conserved, exhibits its greatest activity on the renal tubular epithelium, regulates the reabsorption of water from the kidney, and is used to treat diabetes insipidus. (less)

Reference: Aschenbrenner, D.S., & Venable, S.J. Drug Therapy in Nursing, 4th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2012, Chapter 50: Drugs Affecting Pituitary, Thyroid, Parathyroid, and Hypothalamic Function, p. 1087.


A client who is on estrogen therapy calls the clinic and tells the nurse that she is experiencing sudden, sharp chest pain. The nurse tells the client to go to the emergency department immediately, because the nurse suspects what adverse reaction related to estrogen therapy?

You selected: Pulmonary embolism

Correct

Explanation: Sudden, sharp chest pain that may or may not include hemoptysis is a sign of pulmonary embolism. It may begin as a deep vein thrombosis but the symptoms that the client describes are related to the lungs. Breast tenderness and skeletal pain do not indicate a visit to the emergency department. (less)

Reference: Aschenbrenner, D.S., & Venable, S.J. Drug Therapy in Nursing, 4th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2012, Chapter 52: Drugs Affecting Women’s Health and Sexuality, p. 1133.


Which of the following needs to be used in a child prior to the closure of the bone epiphyses in order to exert its effects? (Choose one)

You selected: Somatropin

Correct

Explanation: Somatropin needs to be used in a child prior to the closure of the bone epiphyses in order to exert its effects. (less)

Reference: Aschenbrenner, D.S., & Venable, S.J. Drug Therapy in Nursing, 4th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2012, Chapter 50: Drugs Affecting Pituitary, Thyroid, Parathyroid, and Hypothalamic Function, p. 1079.


A woman has been prescribed Climara, a transdermal estradiol patch. Which of the following should she be instructed regarding the administration?

You selected: Avoid prolonged sun exposure at the patch site due to increased plasma concentrations.

Correct

Explanation: The total amount of drug absorbed and the resulting plasma drug concentrations from transdermal estrogen can increase during exposure to heat, so patients should be advised to avoid prolonged sun exposure in the area of the patch. The application of heat at the patch site will increase effectiveness. The medication's exposure to sunlight will not increase the risk of breast cancer. The medication's exposure to cold will not change its effectiveness. (less)

Reference: Aschenbrenner, D.S., & Venable, S.J. Drug Therapy in Nursing, 4th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2012, Chapter 52: Drugs Affecting Women's Health and Sexuality, p. 1135.


A 31-year-old pregnant woman has been prescribed administration of a tocolytic drug. During which period is a tocolytic drug usually administered?

You selected: Pre-term labor

Correct

Explanation: Drugs used to prevent uterine contractions are called tocolytics. They are useful in the management of pre-term labor. These drugs will decrease uterine activity and prolong the pregnancy to allow the fetus to develop more fully, thereby increasing the chance of neonatal survival. Oxytocic drugs are used antepartum (before birth of the neonate) to induce uterine contractions and initiate or augment labor. In the postpartum period and during the second stage of normal labor, the tocolytics are not of any importance. (less)

Reference: Aschenbrenner, D.S., & Venable, S.J. Drug Therapy in

Nursing, 4th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2012, Chapter 53, Drugs Affecting Uterine Motility, p. 1162.


A patient you are caring for has both warfarin and testosterone prescribed for separate disease processes. You know that androgens may increase the effects of warfarin by what method of action?

You selected: Speeding up their metabolism

Incorrect

Correct response: Slowing their metabolism

Explanation: Androgens may increase effects of cyclosporine and warfarin, apparently by slowing their metabolism and increasing their concentrations in the blood. Therefore Options C and D are incorrect. (less)

Reference: Aschenbrenner, D.S., & Venable, S.J. Drug Therapy in Nursing, 4th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2012, Chapter 51: Drugs Affecting Men's Health and Sexuality, p. 1113.


The labor and delivery nurse administers ergonovine to a patient after delievery of the placenta. The nurse does this:

You selected: To prevent postpartum hemorrhage

Correct

Explanation: Uterine stimulants increase the strength, duration, and frequency of uterine contractions and decrease the incidence of uterine bleeding. They are given after the delivery of the placenta and are used to prevent postpartum and postabortal hemorrhage caused by uterine atony. (less)

Reference: Aschenbrenner, D.S., & Venable, S.J. Drug Therapy in Nursing, 4th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2012, Chapter 53, Drugs Affecting Uterine Motility, p. 1157.


You are caring for a client with cerebral edema caused by trauma. Which of the following medications would you anticipate being administered?

You selected: Dexamethasone

Correct

Explanation: Dexamethasone is considered the corticosteroid of choice

for cerebral edema associated with brain tumors, craniotomy, or head injury because dexamethasone is thought to penetrate the blood–brain barrier more readily and achieve higher concentrations in cerebrospinal fluids and tissues. (less)

Reference: Aschenbrenner, D.S., & Venable, S.J. Drug Therapy in Nursing, 4th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2012, Chapter 48: Drugs Affecting Corticosteroid Levels, p. 1023.


A patient's medication regimen for treatment of anxiety has been changed from a benzodiazepine to buspirone (BuSpar). The patient asks the nurse what makes this medication safer than the benzodiazepine he has taken. What is the nurse's best response?

You selected: “It will not produce sedation like benzodiazepines.”

Correct

Explanation: Buspirone will not produce sedation. Compared with the benzodiazepines, buspirone (BuSpar) lacks muscle relaxant and anticonvulsant effects; does not cause sedation or physical or psychological dependence; does not increase the CNS depression of alcohol and other drugs; and is not a controlled substance. (less)

Reference: Aschenbrenner, D.S., & Venable, S.J. Drug Therapy in Nursing, 4th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2012, Chapter 15, Drugs Relieving Anxiety and Promoting Sleep, p. 232.


A 75 year old patient is brought to the emergency department by his family. The family relates that the patient is complaining of confusion, seizures and abnormal perception of movement. When the nurse looks at the medication that the family has brought to the ED the nurse discovers that twice the number of tablets are missing from the vial as the orders call for. What should the nurse suspect is wrong with this patient?

You selected: Benzodiapene toxicity

Correct

Explanation: Common manifestations include increased anxiety, psychomotor agitation, insomnia, irritability, headache,

tremor, and palpitations. Less common but more serious manifestations include confusion, abnormal perception of movement, depersonalization, psychosis, and seizures. The scenario does not describe option B, C or D (less)


Flumazenil is the antidote for benzodiazepines and is used to reverse the sedation of benzodiazepines used for diagnostic procedures. Temazepam would be used as a hypnotic. Triazolam is a benzodiazepine used as a hypnotic. Promethazine is an antihistamine with sedative effects. (less)


A patient undergoing treatment with barbiturates is showing symptoms of barbiturate toxicity. Which of the following interventions should the nurse perform?

You selected: Provide respiratory assistance

Correct

Explanation: The nurse must provide respiratory assistance to the patient showing symptoms of barbiturate toxicity. Providing assistance with movement, supportive care, and a safe environment a... (more)



A nurse is caring for a 9-year-old patient and has received an order for diazepam (Valium) 10 mg PO q.i.d. Which of the following should be the nurse's initial action?

You selected: Call the physician and question the order

Correct

Explanation: The first action of the nurse would be to call the physician and question the order. The normal dosage for a pediatric patient is 1 to 2.5 mg PO t.i.d. or q.i.d. This would be an unsafe dose for this patient. If the dosage was changed and the correct amount administered, the nurse would order the medication from the pharmacy if necessary and determine what time to start the medication. She would

then wash her hands in preparation of administering the medication. (less)



A patient who suffers from GERD and diverticulosis has just been admitted to a medical floor. The admitting physician orders cimetadine and a sedative to calm the patient. About what should the nurse be concerned?

You selected: Increased sedative effect

Correct

Explanation: An increased sedative effect may occur when a sedative is given with cimetidine for gastric upset. The other options do not play a role in providing the best care for the patient. (less)


REM deprivation can lead to serious psychological problems, including psychosis.


Which of the following is defined as a drug that induces drowsiness? (Choose one)

You selected: Sedative

Incorrect

Correct response: Hypnotic

Explanation: A hypnotic is defined as a drug that induces drowsiness.



Which action would be least appropriate for the nurse to do after administering an anxiolytic to a patient?

You selected: Dim the lights

Incorrect

Correct response: Having the patient walk to the bathroom

Explanation: Having the patient walk to the bathroom would be appropriate before administering the drug to reduce the

patient's risk for injury. Raising the side rails would be appropriate after administering an anxiolytic. Placing the call light within reach would be appropriate after administering an anxiolytic. Dimming the lights would be appropriate after administering an anxiolytic. (less)



Ms. Mole, a 65-year-old woman with a history of chronic insomnia, is being seen in the physician office for follow-up care. The physician has asked you to develop a plan of care with Ms. Mole to improve her sleep. In addition to drug therapy, what would you recommend as part of the patient's plan of care?

You selected: Advise the patient to avoid food after 6:00 p.m.

Incorrect

Correct response: Advise the patient to practice relaxation techniques.

Explanation: In addition to the drug therapy, patients suffering from chronic insomnia may also need to apply behavioral techniques, such as relaxation therapy. Relaxation techniques such as progressive relaxation and rhythmic breathing allow the muscles to relax and the mind to stop "racing," thereby allowing natural sleep to occur. Smoking cigarettes before bedtime and taking long naps in the afternoon are some of the behaviors associated with chronic insomnia. It is not necessary to avoid all food in the evening. (less)

Reference: Aschenbrenner, D.S., & Venable, S.J. Drug Therapy in Nursing, 4th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2012, Chapter 15: Drugs Relieving Anxiety and Producing Sleep, p. 225.


A patient is admitted to a local health care facility for chronic insomnia. The physician prescribes eszopiclone. What should the nurse teach the patient when administering eszopiclone?

You selected: Avoid drinking alcohol

Correct

Explanation: The nurse should instruct the patient to avoid alcohol during the period of eszopiclone therapy as alcohol interacts with eszopiclone to cause CNS depression. Strenuous work, use of tobacco, and exposure to sunlight

do not cause any adverse reactions. (less)



The daughter of an older adult client asks the nurse if her father should be aware of any special precautions while taking lorazepam (Ativan). What is the nurse’s best response?

You selected: Monitor for increased signs of confusion or forgetfulness.

Correct

Explanation: Recent studies link the chronic use of benzodiazepines by those over 65 years of age to a greater chance of developing dementia. Antianxiety drugs are not known to cause kidney or liver damage but should be used cautiously in elderly clients, and in clients with impaired liver function or impaired kidney function. Antianxiety drugs more likely can cause muscle relaxation than rigidity. A symptom of withdrawal from antianxiety drugs is muscle tension. (less)

Reference: Aschenbrenner, D.S., & Venable, S.J. Drug Therapy in Nursing, 4th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2012, Chapter 15: Drugs Relieving Anxiety and Promoting Sleep, p. 227.


A patient suffers from generalized anxiety disorder. The patient suffers an acute episode of anxiety. Buspirone (BuSpar) is known to be superior to benzodiazepines. Why is the administration of buspirone (BuSpar) not recommended for this patient?

You selected: It takes 2–4 weeks to work.

Correct

Explanation: Buspirone (BuSpar) has a delayed onset of action for up to 2–4 weeks. Thus, buspirone is not useful for acute episodes of anxiety and it may be difficult to persuade some patients to take the drug long enough to be effective. Buspirone (BuSpar) will not cause nausea and vomiting. The administration of this medication orally has no effect on the generalized anxiety disorder. Sexual dysfunction is not an adverse effect of buspirone. (less)


Benzodiazepines are classified in pregnancy category X and their use is contraindicated in pregnancy. (less)

Hydroxyzine (Vistaril) is administered in the preoperative stage to decrease anxiety, nausea, and vomiting. Hydroxyzine (Vistaril) is not given preoperatively to decrease oral secretions. Hydroxyzine (Vistaril) will not cause hypotension. Hydroxyzine (Vistaril) will not cause confusion. (less)


When monitoring a patient receiving escitalopram for therapeutic effectiveness, the nurse would keep in mind that full effect may take up to how long?

You selected: 2 weeks

Incorrect

Correct response: 4 weeks

Explanation: It may take up to 4 weeks before the full effect of a SSRI such as escitalopram is noted.

Reference: Aschenbrenner, D.S., & Venable, S.J. Drug Therapy in Nursing, 4th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2012, Chapter 16, Drugs Treating Mood Disorders, p. 243.


A patient is receiving lithium carbonate for treatment of bipolar disorder. Which of the following statements should be included in discharge education for this patient?

You selected: "Do not drive while on this medication."

Incorrect

Correct response: "Keep your scheduled appointments for measurement of lithium levels."

Explanation: Serum lithium concentrations should be monitored frequently because they vary widely among patients taking similar doses and because of the narrow range between therapeutic and toxic levels. (less)

Reference: Aschenbrenner, D.S., & Venable, S.J. Drug

Therapy in Nursing, 4th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2012, Chapter 16: Drugs Treating Mood Disorders, pp. 266-268.


A patient arrives at the ER after attempting suicide by taking an entire bottle of diazepam. Which of the following drugs will the nurse most likely administer?

You selected: Flumazenil (Romazicon)

Correct

Explanation: Flumazenil is an antidote to benzodiazepine overdose and to reverse the effects of benzodiazepines when used for anesthesia. Phenobarbital, a barbiturate, would further depress the body functions of this patient. Dexmedetomidine is a new hypnotic drug used in ICU for mechanically ventilated patients and ramelteon is also new and used as a hypnotic. Side effects of this drug are depression and suicidal ideation. (less)



Terry, age 46, has a history of bipolar disorder and has been taking lithium for the past 15 years. He recently began showing signs of low thyroid function and changes in his urinary output. Which adverse effect could be affecting Terry's kidneys?

You selected: Lithium causes a decrease in the levels of antidiuretic hormones.

Incorrect

Correct response: Lithium impairs the ability of the kidneys to concentrate urine.

Explanation: Long-term lithium therapy (exceeding 10 years) commonly impairs the ability of the kidneys to concentrate urine, although this effect is not associated with a reduced glomerular filtration rate or with renal insufficiency. Low thyroid function can also occur in patients receiving long-term lithium therapy. (less)

Reference: Aschenbrenner, D.S., & Venable, S.J. Drug Therapy in Nursing, 4th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2012, Chapter 16: Drugs Treating Mood Disorders, p. 266.

Question 17: A nurse is caring for a patient who has been administered

(see full question) a barbiturate. Which of the following are symptoms of barbiturate toxicity that the nurse must monitor the patient for?

You selected: Restlessness

Incorrect

Correct response: Hypotension

Explanation: The nurse must monitor the patient for hypotension, which is one of the symptoms of barbiturate toxicity. Restlessness, euphoria, and confusion are withdrawal symptoms seen in the use of sedatives and hypnotics. (less)


Antidepressant therapy may be indicated if depressive symptoms persist at least 2 weeks, impair social relationships or work performance, and occur independently of life events.


The mother of a child newly diagnosed with resistant epilepsy asks the nurse why two AEDs have been prescribed for her daughter. What would be the nurse's best answer?

You selected: Decreased risk of side effects

Incorrect

Correct response: To minimize seizures in resistant epilepsy

Explanation: When monotherapy is ineffective, a second, and sometimes a third, drug may be added. It does not decrease overall cost or reduce the risk of side effects or increase movement of sodium ions into the cell. (less)

Reference: Aschenbrenner, D.S., & Venable, S.J. Drug Therapy in Nursing, 4th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2012, Chapter 18, Drugs Treating Seizure Disorders, p. 313.


The mother of a child newly diagnosed with resistant epilepsy asks the nurse why two AEDs have been prescribed for her daughter. What would be the nurse's best answer?

You selected: Decreased risk of side effects

Incorrect

Correct response: To minimize seizures in resistant epilepsy

Explanation: When monotherapy is ineffective, a second, and sometimes a third, drug may be added. It does not decrease overall cost or reduce the risk of side effects or increase movement of sodium ions into the cell. (less)

Reference: Aschenbrenner, D.S., & Venable, S.J. Drug Therapy in Nursing, 4th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2012, Chapter 18, Drugs Treating Seizure Disorders, p. 313


A client tells the nurse he is going to stop taking his medication because he is always having fine tremors and slurred speech. These reactions are preventing him from teaching art classes like he used to do. The nurse knows that which of the following could help him?

You selected: • He could tell his doctor that the antipsychotics are not working and he needs a larger dose, or another medication added. • He could talk with his doctor and ask to have his medication dosage decreased, or change his medication to a second-generation antipsychotic.

Incorrect

Correct response: • He could talk with his doctor and ask to have his medication dosage decreased, or change his medication to a second-generation antipsychotic.

Explanation: Fine tremors and slurred speech are common symptoms of extrapyramidal syndrome. Symptoms may decrease if the amount of the medication is decreased or if the client is changed to a second-generation antipsychotic medication. A large dose of medication or adding another first-generation antipsychotic medication would increase the symptoms. Changing his profession may be necessary, but getting on the correct drug and dosage is of primary concern. Schizophrenia is not cured by the antipsychotic medications. The symptoms are managed, so by stopping the drug the client is at risk of showing all the symptoms of schizophrenia. (less)

Reference: Aschenbrenner, D.S., & Venable, S.J. Drug Therapy in Nursing, 4th ed., Philadelphia: Wolters Kluwer

Health/Lippincott Williams & Wilkins, 2012, Chapter 17: Drugs Treating Psychotic Disorders and Dementia, p. 286.


A client tells the nurse he is going to stop taking his medication because he is always having fine tremors and slurred speech. These reactions are preventing him from teaching art classes like he used to do. The nurse knows that which of the following could help him?

You selected: • He could tell his doctor that the antipsychotics are not working and he needs a larger dose, or another medication added. • He could talk with his doctor and ask to have his medication dosage decreased, or change his medication to a second-generation antipsychotic.

Incorrect

Correct response: • He could talk with his doctor and ask to have his medication dosage decreased, or change his medication to a second-generation antipsychotic.

Explanation: Fine tremors and slurred speech are common symptoms of extrapyramidal syndrome. Symptoms may decrease if the amount of the medication is decreased or if the client is changed to a second-generation antipsychotic medication. A large dose of medication or adding another first-generation antipsychotic medication would increase the symptoms. Changing his profession may be necessary, but getting on the correct drug and dosage is of primary concern. Schizophrenia is not cured by the antipsychotic medications. The symptoms are managed, so by stopping the drug the client is at risk of showing all the symptoms of schizophrenia. (less)

Reference: Aschenbrenner, D.S., & Venable, S.J. Drug Therapy in Nursing, 4th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2012, Chapter 17: Drugs Treating Psychotic Disorders and Dementia, p. 286.


A patient with advanced-stage Alzheimer's disease is seen by a physician who prescribes a newer drug that is not a cholinesterase inhibitor. This drug is a N-methyl-D-asparate (NMDA) receptor antagonist. This drug is better known as which of the following?

You selected: aricept

Incorrect

Correct response: namenda

Explanation: Cholinesterase inhibitors are not used in late stage Alzheimer's disease. A newer group of drugs, NMDA receptor antagonists, is available. Namenda is thought to work by decreasing the excitability of neurotransmission caused by an excess of the amino acid glutamate in the CNS. (less)

Reference: Aschenbrenner, D.S., & Venable, S.J. Drug Therapy in Nursing, 4th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2012, Chapter 17, Drugs Treating Psychotic Disorders and Dementia, p. 291.


Why does phenytoin increase the risk for neonatal hemorrhage in the first 24 hours after birth?

You selected: Phenytoin is highly protein bound.

Incorrect

Correct response: Phenytoin is a competitive inhibitor of vitamin K.

Explanation: Because phenytoin is a competitive inhibitor of vitamin K, it increases the risk for neonatal hemorrhage in the first 24 hours after birth. The risk for neonatal hemorrhage is not increased because phenytoin is highly protein bound, reversibly binds to sodium channels while they are in the inactive state, and selectively works at neurons that are firing abnormally. The defect is characterized by low levels of vitamin K–dependent clotting factors, prolonged prothrombin times or partial thromboplastin times, or both. (less)

Reference: Aschenbrenner, D.S., & Venable, S.J. Drug Therapy in Nursing, 4th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2012, Chapter 18: Drugs Treating Seizure Disorders, p. 300.

A serum carbamazepine level of 14 mcg/mL is over the therapeutic range of 4 to 12 mcg/mL, necessitating a reduction in dosage. A serum carbamazepine level of 6 mcg/mL is within the th... (more)


A patient has been administered donepezil HCL for dementia. The patient has informed the nurse that she has

also been taking nonsteroidal anti-inflammatory drugs. Which of the following interactions should the nurse monitor for in this patient?

You selected: Decreased effectiveness of anticholinergics

Incorrect

Correct response: Increased risk of GI bleeding

Explanation: The interaction of nonsteroidal anti-inflammatory drugs with cholinesterase inhibitors causes increased risk of GI bleeding, which should be monitored for. Interaction of anticholi... (more)

Reference: Aschenbrenner, D.S., & Venable, S.J. Drug Therapy in Nursing, 4th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2012, Chapter 17, Drugs Treating Psychotic Disorders and Dementia, p. 290.


Gabapentin is frequently used to treat neuropathies. Under which of the following conditions should the first dose of the drug be given?

You selected: In the morning with food

Incorrect

Correct response: At bedtime

Explanation: The initial dose of gabapentin should be given at bedtime, because it can cause significant somnolence and dizziness. (less)





Incorrect



Reference: Aschenbrenner, D.S., & Venable, S.J. Drug Therapy in Nursing, 4th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2012, Chapter

18: Drugs Treating Seizure Disorders, p. 313.

Methsuximide is administered orally. Diazepam can be administered rectally. Diazepam or phenobarbital may be administered intramuscularly. Diazepam, fosphenytoin, phenytoin, valproic acid, and phenobarbital can be administered intravenously. (less)


While taking the vital signs of a hospitalized client admitted for seizure control due to epilepsy, the nurse notices a bloody toothbrush on the client’s bedside table and scattered bruising over the client’s extremities. What is the nurse’s best action?

You selected: Document the findings and offer the client a soft-bristled toothbrush.

Incorrect

Correct response: Report the findings to the primary health care provider immediately.

Explanation: The client has a history of epilepsy and is likely taking anticonvulsants. Hematologic changes when taking anticonvulsants needs to be reported immediately to the health care provider. Such changes include bleeding gums and easy bruising. Abuse is not the likely cause of the client’s bruising given the history of epilepsy. Telling the client to ask for assistance when ambulating and offering a soft toothbrush are appropriate, but the health care provider needs to be notified immediately about the hematologic changes. (less)



Which of the following best reflects the action of barbiturates when used to control seizures?

You selected: Stimulation of the cerebral cortex

Incorrect

Correct response: Inhibition of impulse conduction

Explanation: Barbiturates inhibit impulse conduction in the ascending reticular activating system. Barbiturates depress the cerebral cortex. Barbiturates depress cerebellar functioning. Barbiturates depress motor nerve output. (less)

Reference: Aschenbrenner, D.S., & Venable, S.J. Drug Therapy in Nursing, 4th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2012, Chapter 18,

Drugs Treating Seizure Disorders, p. 314.


While taking the vital signs of a hospitalized client admitted for seizure control due to epilepsy, the nurse notices a bloody toothbrush on the client’s bedside table and scattered bruising over the client’s extremities. What is the nurse’s best action?

You selected: Document the findings and offer the client a soft-bristled toothbrush.

Incorrect

Correct response: Report the findings to the primary health care provider immediately.

Explanation: The client has a history of epilepsy and is likely taking anticonvulsants. Hematologic changes when taking anticonvulsants needs to be reported immediately to the health care provider. Such changes include bleeding gums and easy bruising. Abuse is not the likely cause of the client’s bruising given the history of epilepsy. Telling the client to ask for assistance when ambulating and offering a soft toothbrush are appropriate, but the health care provider needs to be notified immediately about the hematologic changes. (less)



Which of the following best reflects the action of barbiturates when used to control seizures?

You selected: Stimulation of the cerebral cortex

Incorrect

Correct response: Inhibition of impulse conduction

Explanation: Barbiturates inhibit impulse conduction in the ascending reticular activating system. Barbiturates depress

the cerebral cortex. Barbiturates depress cerebellar functioning. Barbiturates depress motor nerve output. (less)



Which of the following would the nurse include as possible adverse effects when teaching a patient about phenytoin?

You selected: Liver toxicity

Correct

Explanation: Liver toxicity is a potential adverse effect of phenytoin. Constipation, not diarrhea, is an adverse effect of phenytion. Bone marrow suppression and leukopenia would be adverse effects of phenytoin. Physical dependence is an adverse effect associated with the use of benzodiazepines. (less)

Reference: Aschenbrenner, D.S., & Venable, S.J. Drug Therapy in Nursing, 4th ed., Philadelphia:

Wolters Kluwer Health/Lippincott Williams & Wilkins, 2012, Chapter 18, Drugs Treating Seizure Disorders, p. 300.


Tonic-clonic seizures and myoclonic seizures are classified as what type of seizures? (Choose one)

You selected: Partial seizures

Incorrect

Correct response: Generalized seizures

Explanation: Tonic-clonic seizures and myoclonic seizures are classified generalized seizures.



Dilantin has several side effects. When teaching the patient about these side effects, which symptom would indicate a life-threatening condition and should be reported to the health care provider immediately?

You selected: Shortness of breath

Incorrect

Correct response: Rash with itching

Explanation: Shortness of breath, alteration in taste, and altered bowel function

are all side effects or adverse reactions that a patient may experience when taking Dilantin. If the patient has a rash with itching, this could indicate a life-threatening adverse reaction such as Stevens-Johnson syndrome. (less)



An 80-year-old patient has severe pain after a case of shingles. The pain is noted along the shoulder and back. He states the pain is so severe he cannot sleep. What is the primary medication that will relieve this pain?

You selected: Morphine sulfate (MS Contin)

Incorrect

Correct response: Gabapentin (Neurontin)

Explanation: Gabapentin is the first oral medication approved by the FDA for the management of postherpetic neuralgia. Meperidine will provide pain relief but is not effective in postherpetic neuralgia. Morphine sulfate will provide pain relief but is not effective in postherpetic neuralgia. Naproxen sodium will decrease inflammation but is not effective for postherpetic neuralgia. (less)



After teaching a group of students about anti-seizure agents, the instructor determines that the teaching was successful when the students identify which agent as being administered intravenously?

You selected: Carbamazepine

Incorrect

Correct response: Fosphenytoin

Explanation: Fosphenytoin is administered intravenously. Gabapentin is administered orally. Felbamate is administered orally. Carbamazepine is administered orally. (less)

Reference: Aschenbrenner, D.S., & Venable, S.J. Drug Therapy in Nursing, 4th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2012, Chapter 18, Drugs Treating Seizure Disorders, pp. 299, 306



Incorrect




Which of the following would be most important for the nurse to monitor when administering valproic acid?

You selected: Complete blood count

Incorrect

Correct response: Liver function studies

Explanation: Valproic acid is associated with liver toxicity. It would be most important to monitor the patient's liver function studies.... (more)



A patient has been started on dantrolene (Dantrium). What is the most serious adverse effect on which the patient should be instructed?

You selected: Metabolic acidosis

Incorrect

Correct response: Fatal hepatitis

Explanation: The most serious adverse effect of oral dantrolene is fatal hepatitis. Metabolic acidosis, hypercarbia, and renal calculi are not adverse effects of oral dantrolene. (less)

Reference: Aschenbrenner, D.S., & Venable, S.J. Drug Therapy in Nursing, 4th ed., Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, 2012, Chapter 20, Drugs Affecting Muscle Spasm and Spasticity, p. 354.

Hypotension is the most significant adverse effect of tizanidine. Dark black urine, excessive salivation, and eczema are not adverse effects of tizanidine. (less)

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