Abrams’ Clinical Drug Therapy Rationales For

Nursing Practice By Geralyn Frandsen -Test Bank

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Abrams’ Clinical Drug Therapy Rationales for

Nursing Practice by Geralyn Frandsen -Test Bank
Sample Test
Chapter 3- Medication Administration and the Nursing
1. An infant’s current weight indicates that the maximum safe dose of Tylenol is 30 mg by mouth. The phy
65 mg to be given, and the nurse administers Tylenol 65 mg. Who is legally responsible in the event that
a toxic reaction to the medication?
A) The nurse
B) The pharmacist
C) The physician
D) The pharmacy technician
Ans: A
Feedback:
When giving medications, the nurse is legally responsible for safe and accurate administration. This reg
 that the nurse may be held liable for not giving a drug or for giving a wrong drug or dose. The phar
responsible for filling the medication order, but if an error exists in the order and the medication is still ad
the nurse, the nurse is the most responsible. If the physician writes the order but does not administer th
then the physician is not legally responsible. The pharmacy technician is not legally responsib

2. An 80-year-old patient with risk factors for thrombophlebitis is to be administered heparin 5000 units sub
The heparin vial is labeled 10,000 units/mL. How many milliliters will the nurse administer to the p
A) 50 mL
B) 1.5 mL
C) 5 mL
D) 0.5 mL
Ans: D
Feedback:
5000 units/X = 10,000 units/1 mL.

3. The physician orders potassium chloride 40 mEq to be added to the patient’s IV solution. The vial reads
How many milliliters will be added to the IV solution?
A) 0.25 mL
B) 20 mL
C) 200 mL
D) 40 mL
Ans: B
Feedback:
40 mEq/X mL = 10 mEq/5 mL.

4. You have received an order for a medication to be administered buccally. Where is the medication ad
A) Eye
B) Vagina
C) Cheek
D) Nose
Ans: C
Feedback:
A medication that has been ordered to be administered buccally is given in the patient’s cheek. The eye
 nose are not considered part of the buccal mucosa.

5. The nurse is repeatedly unsuccessful in starting an IV on a patient who requires antibiotic therapy. The p
orders the patient to receive an oral antibiotic. What is the major disadvantage of the oral route over th
route?
A) Slower rate of action
B) Greater adverse effects
C) Increased risk of tolerance
D) Dose must be larger.
Ans: A
Feedback:
The oral route of administration has a slower rate of action. Oral antibiotics do not produce greater adv
The risk of tolerance is equal in intravenous and oral antibiotics. The dose is not necessarily larger in
intravenous antibiotics.

6. A patient has a gastrostomy tube, and the pharmacy has delivered an extended-release tablet. What
appropriate action taken by the nurse?
A) Administer the medication orally.
B) Administer the medication through the tube.
C) Crush the medication and administer half of it at a time.
D) Call the pharmacy to obtain an immediate-release form.
Ans: D
Feedback:
The most important nursing action is to call the pharmacy to determine whether a liquid or a nonexten
tablet can be substituted. Extended-release tablets should never be crushed—the patient would be plac
overdose or potentially serious adverse effects or death. If the patient has a gastrostomy tube, then he
swallow and cannot take the pill orally. The medication cannot be administered through the tube bec
obstruct the tube.

7. The nurse has measured a patient’s capillary blood glucose and is preparing to administer NPH insulin.
following actions should the nurse perform?
A) Administer intramuscularly.
B) Rotate the liquid.
C) Vigorously shake the vial.
D) Administer intradermally.
 Ans: B
Feedback:
When administering NPH insulin, particles of active drug are suspended in a liquid; the liquid must be r
insulin is administered subcutaneously, not intramuscularly or intradermally. The vial should be rotated o
not vigorously shaken.

8. A nurse begins a patient interaction by systematically gathering information on the patient’s care and
evaluating the outcomes of care. Which of the following represents this continuum of care?
A) Assessment process
B) Outcomes analysis
C) Nursing interventions
D) Nursing process
Ans: D
Feedback:
The nursing process is a systematic way of gathering and using information to plan and provide individu
care and to evaluate the outcomes of care. The assessment, outcomes, and nursing interventions are
components of the nursing process.

9. Which of the following assessments should be made before administering a new medication
A) Determine the patient’s past medication history.
B) Evaluate the patient’s health beliefs.
C) Instruct the patient on the effect of the medication.
D) Teach the patient about the desired outcomes of drug therapy.
Ans: A
Feedback:
Assessment involves collecting data on patient characteristics known to affect drug therapy. This proc
observing and interviewing the patient, interviewing family members, completing a physical assessmen
medical records for pertinent laboratory and diagnostic reports, and other methods. Initially (before dru
started or on first contact), the patient should be assessed for age, weight, vital signs, health status,
conditions, and ability to function in usual activities. It is not necessarily important to evaluate the pati
beliefs at this point. Education is considered to be an intervention, not an assessment.

10. A patient states that she takes acetaminophen (Tylenol) four to five times daily when she is at home. W
following laboratory tests is a relevant response to this practice?
A) Cardiac enzymes
 B) Peak and trough
C) Liver enzymes
D) White blood cell count
Ans: C
Feedback:
Laboratory tests of liver, kidney, and bone marrow function are often helpful because some drugs may d
organs. Cardiac enzymes are assessed in the event that the patient has had myocardial infarction sym
peak and trough indicates the amount of medication when half the medication has been excreted and th
of the medication prior to the administration of the next dose. The white blood cell count is indicative in
agranulocytosis or infection.

11. A patient who has been diagnosed with type 2 diabetes mellitus is being instructed on her medication r
and exercise. She is having difficulty grasping information about when exactly she should administer ins
the following nursing diagnoses is most appropriate for this patient?
A) Deficient knowledge: drug therapy regimen
B) Noncompliance: overuse
C) Risk for injury related to adverse effects
D) Acute confusion related to insulin regimen
Ans: A
Feedback:
Deficient knowledge: drug therapy regimen is the most accurate nursing diagnosis for this patient. The q
not address noncompliance: overuse. The patient is not necessarily at risk for injury based on the stem o
Acute confusion does not relate to a lack of understanding or knowledge.

12. A patient is diagnosed with pneumonia and has been placed on antibiotics to treat the infection. Which o
nursing actions will assist in increasing lung capacity?
A) Promoting hand hygiene
B) Increasing rest
C) Frequent repositioning
D) Promoting deep breathing
Ans: D
Feedback:
Assisting the patient to cough and deep breathe will increase lung capacity and assist in fighting the
Promoting hand hygiene is important but will not increase lung capacity. Increasing rest will assist in rec
not increase lung capacity. Frequent repositioning does not increase lung capacity.
13. The nurse is providing care for a patient who has rheumatoid arthritis. Which of the following herbal su
often combined with chondroitin to repair cartilage?
A) Ginkgo
B) Glucosamine
C) St. John’s wort
D) Saw palmetto
Ans: B
Feedback:
Glucosamine is an herbal supplement that is usually combined with chondroitin to repair cartilage. Gink
improve memory and cognitive function in people with Alzheimer’s disease. St. John’s Wort is used
depression. Saw palmetto is used to treat urinary symptoms in men with benign prostatic hyperp

14. The nurse makes an effort to provide high-quality care to patients by obtaining and analyzing the bes
scientific research. This activity demonstrates an important component of which of the followi
A) Evidence-based nursing
B) Medical justification
C) Nursing data synthesis
D) Scientific nursing
Ans: A
Feedback:
Evidence-based nursing practice requires a conscientious and continuing effort to provide high-quality c
by obtaining and analyzing the best available scientific evidence from research. Then, the scientific e
integrated with the nurse’s clinical expertise and the patient’s preferences and values to yield “best p ra
patient with a particular disease process or health problem.

15. A patient has informed the nurse that he has begun supplementing his medication regimen with a seri
remedies recommended by his sister-in-law. Which of the following is the most important nursing res
regarding herbal supplements?
A) Research for potential interactions with medications.
B) Instruct the patient to discontinue them if taking prescription medications.
C) Instruct the patient to take the supplements 1 hour before prescription medications
D) Instruct the patient to take the supplements 3 hours after prescription medications
Ans: A
Feedback:
 Two major concerns are that the use of supplements may keep patients from seeking treatment from a
provider and that products may interact with prescription drugs. Not all herbal supplements should be di
combination with prescription medications. The herbal supplements should be administered in varying q
at varying times based on the medication regime. They are not always administered 1 hour before p
medications or 3 hours after prescription medications.

16. A patient is being administered a selective serotonin reuptake inhibitor to treat depression. Which of t
herbal supplements is contraindicated?
A) St. John’s wort
B) Glucosamine
C) Chondroitin
D) Melatonin
Ans: A
Feedback:
St. John’s wort should not be combined with monoamine oxidase inhibitors or selective serotonin reupt
antidepressants.

17. A pediatric nurse confronts many challenges when providing medications to children and infants. Wh
following principles is most appropriate when administering medication to children?
A) If a child is resistant to taking the medication, the nurse should tell the child that it is ca
B) Measurement by teaspoons is as accurate as milliliters.
C) If a drug is not supplied in liquid form, the nurse can always crush the pill.
D) Assess the child’s weight prior to initial drug administration.
Ans: D
Feedback:
It is imperative to determine a child’s weight in order to ensure safe dosage. Never describe the medicat
as candy. Liquid medications should always be measured by milliliters, not teaspoons. Some, but not al
may be safely crushed.

18. An 88-year-old woman has developed syncope (fainting) since an antihypertensive agent was added to h
regime. The development of syncope may be related to which of the following physiologic proce
A) Interaction of other medications
B) Ingestion of herbal supplements
C) Diminished excretion of the medication
D) Increased metabolism of the medication
 Ans: C
Feedback:
Adverse effects of medications in an elderly patient are likely because of physiologic changes associate
pathologic changes due to disease processes, multiple drugs for acute and chronic disorders, impaired
cognition, and difficulty in complying with drug orders. The question does not address the interactio
medications. The question does not identify any herbal supplements. Based on physiologic alterations, t
not have increased metabolism of the medication.

19. A nurse is preparing to administer a patient’s scheduled beta-adrenergic blocker. The nurse is aware tha
receiving this drug for the treatment of hypertension. The nurse has addressed which of the following r
medication administration?
A) Right indication
B) Right diagnosis
C) Right reason
D) Right history
Ans: C
Feedback:
“Right reason” is one of the universally recognized rights of safe drug administration. The other listed “r
used in practice.

20. A nurse is preparing to administer an intramuscular injection of an older adult’s seasonal influenza vacc
size needle should the nurse use to administer the injection?
A) 16 gauge
B) 20 gauge
C) 24 gauge
D) 28 gauge
Ans: B
Feedback:
Usually, a 25-gauge, 5/8-inch needle is used for Sub-Q injections and a 22- or 20-gauge, 1 1/2-inch nee
IM injections.

Chapter 5- Pharmacology and the Care of the Adult

1. An 80-year-old woman has sought care for a dermatological health problem that most often requires trea
oral corticosteroid. When considering whether to prescribe steroids to this patient, the care provider sho
which of the following questions?
A) “Should this patient receive a medication that was likely tested on younger adults?
 B) “Do the potential benefits of this medication outweigh the potential harm?”
C) “Are there plausible herbal or complementary alternatives to this medication?”
D) “Is there a younger adult who can oversee this patient’s medication regimen?”
Ans: B
Feedback:
The nurse and the prescriber must carefully consider the risk of associated adverse effects of those me
well as possible benefits these medications might have in changing physiological processes related to d
consideration is a priority over the specifics of the drug’s original testing procedure or the presence
alternatives. Not every older adult requires another person to oversee his or her medication

2. A nurse is teaching an 81-year-old man about the risk for potential adverse effects before he begins
antibiotics for an upper respiratory infection. What characteristic of older adults predisposes them to a
reaction?
A) Increased excretion time due to increased bowel motility
B) Impaired distribution due to polypharmacy
C) A decrease in overall body surface area
D) A decrease in the number of receptors needed for distribution
Ans: D
Feedback:
Older adults are prone to adverse drug reactions because of a decrease in the number of receptors nee
distribution. BSA does not change appreciably with age and bowel motility slows with age. Polypharma
concern, but this phenomenon does not primarily involve distribution.

3. A nurse is conducting a medication reconciliation of a woman who is newly admitted to a long-term care
appraising the woman’s medication regimen in light of the Beers Criteria, the nurse will look
A) drugs that are known to cause adverse effects in older adults.
B) drugs for which generic equivalents are available at lower cost.
C) drugs that have been found to be ineffective in older adults.
D) drugs that are known to exacerbate the aging process.
Ans: A
Feedback:
Dr. Mark Beers developed the Beers Criteria list of potentially inappropriate medications used by the
population. The list confirms that toxic medication effects and drug-related problems affect the safety o
and names drugs that cause problems in this population.
4. A nurse has noted that an older adult patient on an acute care for elders (ACE) unit has an exception
medication administration record. The nurse has alerted the pharmacist because one of the patient’s lo
medications appears on the Beers list. What medication is the nurse likely addressing?
A) Low-dose enteric-coated ASA
B) Metoprolol (Lopressor)
C) Digoxin (Lanoxin)
D) Vitamin D
Ans: C
Feedback:
Digoxin appears on the list of Beers Criteria due to the risk of adverse effects in older adults. ASA, me
vitamin D do not appear on this list.

5. A nurse has called an elderly patient’s surgeon to question the order for meperidine hydrochloride (Dem
control. The nurse’s action is prompted by the possibility of what adverse effect associated with the use
older adults?
A) Confusion
B) Blood dyscrasias
C) Gastrointestinal bleeding
D) Hepatotoxicity
Ans: A
Feedback:
Demerol is associated with confusion in older adults. It is not noted to cause blood dyscrasias, GI bl
hepatotoxicity.

6. A gerontological nurse is aware that older adults’ abilities to excrete medications diminish with age. Wh
an older adult’s ability to excrete medications, what laboratory or diagnostic finding should the nurse
A) Renal ultrasound
B) Complete blood count (CBC)
C) Serum bilirubin and albumin levels
D) Blood urea nitrogen and creatinine levels
Ans: D
Feedback:
The nurse should assess an older adult’s blood urea nitrogen and creatinine clearance (CrCl) levels to
patient’s ability to excrete the medications. Renal ultrasound identifies structural abnormalities in the k
less useful in diagnosing function. The patient’s CBC and bilirubin and albumin levels do not help the nu
 patient’s ability to excrete medications.

7. A 90-year-old patient’s most recent blood work includes the following data: alanine aminotransferase
mkat/L (high) and aspartate aminotransferase (AST) 3.1 mkat/L (high). What implication do these data
patient’s pharmacokinetics?
A) Distribution of drugs may be erratic.
B) Absorption of drugs may be incomplete.
C) Excretion of drugs may be delayed.
D) Metabolism of drugs may be impaired.
Ans: D
Feedback:
AST and ALT levels are used to determine the patient’s liver function and ability to metabolize d

8. A 72-year-old woman with a 60-pack-year history of cigarette smoking has developed chronic obstructiv
disease (COPD) and has consequently been prescribed albuterol, a beta 2-adrenergic agonist. When adm
medication, the nurse should be aware that
A) the drug carries a higher potential for hepatotoxicity in this patient than in a younger pa
B) the drug may be less effective than in a younger patient due to decreased beta-receptor f
C) the patient will need to take a beta-adrenergic blocker concurrently to mitigate the likelihood
effects.
D) the patient will need to have serial complete blood counts (CBCs) drawn following the initiation
Ans: B
Feedback:
Beta-adrenergic agonists are less effective in older adults as a result of the decreased function of the b
system. The potential for hepatotoxicity is not increased, and a beta-blocker is not indicated. Serial bloo
necessary.

9. The daughter of an 80-year-old woman states that her mother has been taking alendronate (Fosamax
years for the treatment of osteoporosis. The daughter tells the nurse that her mother never had any co
nausea after taking this medication until recently. How should the nurse respond to the daughter’s s
A) “It could be that your mother’s stomach empties more slowly than it used to, which is a normal re
B) “As your mother gets older, the medication travels down her esophagus more slowly than it use
cause nausea.”
C) “Because your mother processes drugs more slowly than when she was younger, there is mor
which they can cause nausea.”
 D) “As your mother ages, she has more of the receptors that trigger nausea. This is a normal ch
accompanies the aging process.”
Ans: A
Feedback:
Diminished gastric emptying also plays a role by causing the medication to be in the stomach for a longe
factor increases the risk of developing nausea and vomiting, thus causing elimination of the medication
promoting fluid volume deficit. This phenomenon is not attributable to receptor changes or decreased
motility.

10. An older adult’s most recent blood work reveals that his serum albumin level is 21 g/L (low). This will m
what aspect of pharmacokinetics?
A) Absorption
B) Distribution
C) Metabolism
D) Excretion
Ans: B
Feedback:
Many medications require serum albumin to bind, transport, and distribute the medication to the target
event that the amount of serum albumin is insufficient, the amount of free drug rises and the effect of the
intense.

11. Laboratory testing of an 80-year-old patient who is well-known to the clinic nurse indicates that his liver
been gradually decreasing over the last several years. How will this age-related physiological change in
metabolism?
A) The patient will metabolize drugs more quickly but derive less of a therapeutic benefit from
B) The liver will sequester drug molecules in the hepatocytes, and they will be released at unpred
C) Many of the patient’s medications will remain in his body for a longer time.
D) The patient’s kidneys will be forced to metabolize a disproportionate quantity of medica
Ans: C
Feedback:
The hepatic enzymes of the liver are decreased in the older adult, altering the ability to remove metaboli
It is important to understand that because older adults have a reduced metabolism, medications with a
will remain in the body for a greater amount of time. The kidneys do not compensate for this loss of funct
not normally sequestered in the liver tissue.

12. A gerontological nurse is aware that age is a salient variable that must be considered during pharmac
 adults. However, the nurse knows that many other important variables must also be considered, includ
Members of which of the following ethnic groups typically require lower doses of many common med
A) Native Americans
B) Caucasian Americans
C) Asian Americans
D) African Americans
Ans: C
Feedback:
Caucasian Americans and African Americans are poor metabolizers of medication compared with Asian
Asian Americans have the ability to metabolize and excrete medications more quickly than those of Ca
African descent. This often means that Asian Americans require lower doses.

13. A nurse is reviewing a new patient’s admission blood work, which indicates that the patient’s glomerular
is 51 mL/min/1.73 m 2 (low). What implication does this have for the patient’s subsequent pharmaco
A) The patient may need lower-than-normal doses of some medications.
B) The patient may require a fluid challenge prior to medication administration.
C) The patient may need IV administration of a hypotonic solution to aid medication excre
D) The patient may need to receive medications by topical and subcutaneous routes rather than
Ans: A
Feedback:
With a decreased GFR, it is necessary to reduce the dosage of the medication. IV fluid administration a
routes do not adequately compensate for this change in pharmacokinetics.

14. A 69-year-old man has been prescribed a nitrate and a calcium channel blocker for the treatment of uns
When performing health education to promote adherence to his medication regimen, the nurse should
which of the following?
A) The fact that the patient will likely need medications until he no longer experiences the signs
B) The fact that the patient should take his medications as ordered even if he feels well in the s
C) The fact that inconsistent medication use will likely cause the onset of hypertension
D) The fact that he should gauge his day’s dose based on how he feels that morning
Ans: B
Feedback:
Being asymptomatic may contribute to nonadherence to a medication regimen. Many patients begin to f
the initiation of therapy and then discontinue medications altogether or miss individual doses. Patient
families should be educated about adherence to medication regimens and taught to not skip doses, eve
 well. Inconsistent use of nitrates and calcium channel blockers does not normally lead to hyperte

15. Mrs. James has been taking a diuretic and a beta-blocker for the treatment of hypertension for the pa
months. During her latest clinic visit, she states that she has been measuring her blood pressure regular
drug store and she claims that it is usually in the range of 130/80 mm Hg. As a result, she states that she
on her doses of both drugs. Mrs. James’ actions should indicate what nursing diagnosis to the n
A) Risk for poisoning related to unilateral changes to medication regimen
B) Acute confusion related to the necessity for medication adherence
C) Readiness for enhanced decision making related to management of drug therapy
D) Deficient knowledge related to self-management of drug regimen
Ans: D
Feedback:
Mrs. James is evidently unaware of the need to take her medications consistently. She is presuming th
control means that the medication is no longer indicated. The nurse should address this lack of knowledg
associated risk of poisoning, and the patient’s decision making is deficient, a fact that she may or may n
address. Acute confusion denotes a deficit in cognitive processes, not a lack of information

16. A nurse at a long-term care facility is surprised to learn that a new resident’s medication administration
four pages in length. The nurse knows that polypharmacy carries which of the following risks for older a
all that apply.
A) Increased risk of complications
B) Decreased continuity of care
C) Decreased cognition
D) Decreased medication adherence
E) Decreased costs of care
Ans: A, C
Feedback:
Polypharmacy and the consequent interactions of medications can lead to greater complications and
mental status. It does not necessarily reduce the continuity of care or medication adherence. Costs to th
likely to be higher, not lower.