Which term describes what the body does to a drug through absorption, distribution, metabolism and excretion?
Pharmacokinetics
✓
Pharmacodynamics
Pharmacogenetics
Pharmacotherapeutics
Correct Answer
Pharmacokinetics
Pharmacokinetics is the study of how the body handles a drug through its four processes: absorption, distribution, metabolism and excretion. Pharmacodynamics is the reverse view, what the drug does to the body. Pharmacogenetics studies how inherited genetic variation changes drug response. Pharmacotherapeutics is the use of drugs to treat disease.
Category: Pharmacokinetics
Question 2
An oral drug is absorbed into the portal circulation, and the liver metabolizes part of it before it reaches the systemic circulation. What is this process called?
Protein binding
First-pass effect
✓
Glomerular filtration
Drug tolerance
Correct Answer
First-pass effect
In the first-pass effect, liver enzymes metabolize part of an oral dose before it reaches the general circulation, which is why oral doses are often larger than IV doses. Protein binding is the attachment of drug to plasma proteins such as albumin. Glomerular filtration is how the kidneys remove water-soluble drugs. Drug tolerance is a reduced response after repeated use.
Category: Pharmacokinetics
Question 3
A highly protein-bound drug is displaced from its binding sites by a second drug. What is the expected result?
Less free drug and a weaker effect
Faster absorption from the GI tract
More free drug and a greater risk of toxicity
✓
No change in the drug's effect
Correct Answer
More free drug and a greater risk of toxicity
Only unbound drug can act on receptors, so displacing a drug from albumin raises the free fraction and can intensify its effects to the point of toxicity. Less free drug and a weaker effect is the opposite of what happens. Faster absorption from the GI tract is unrelated, since binding occurs after the drug is in the blood. No change in the drug's effect ignores the rise in active drug.
Category: Pharmacokinetics
Question 4
A client receives a single 400 mg dose of a drug with a half-life of 6 hours. Assuming no further doses, how much drug remains in the body after 18 hours?
200 mg
100 mg
25 mg
50 mg
✓
Correct Answer
50 mg
Eighteen hours is three half-lives of 6 hours, so the amount halves three times: 400 mg to 200 mg, then 100 mg, then 50 mg. 200 mg is the amount after one half-life. 100 mg is the amount after two half-lives. 25 mg would remain after four half-lives, or 24 hours.
Category: Pharmacokinetics
Question 5
Which term describes a drug that binds to a receptor without activating it and blocks the effects of agonists?
Antagonist
✓
Full agonist
Partial agonist
Enzyme inducer
Correct Answer
Antagonist
An antagonist occupies a receptor without stimulating it, preventing agonists or the body's own chemicals from acting; beta-blockers work this way. Full agonist describes a drug that binds and fully activates a receptor. Partial agonist describes a drug that activates a receptor only moderately. Enzyme inducer describes a drug that speeds the metabolism of other drugs rather than blocking a receptor.
Category: Pharmacodynamics
Question 6
A drug has a narrow therapeutic index. Which nursing consideration applies?
Monitoring is unneeded because the drug is very safe
Close monitoring, because small dose changes can cause toxicity
✓
Doubling the next dose if one dose is missed
Giving it only by the oral route
Correct Answer
Close monitoring, because small dose changes can cause toxicity
With a narrow therapeutic index, the safe and effective range is small, so a slight excess causes toxicity and a slight shortfall leaves the drug ineffective; drug levels and effects are often monitored. Monitoring is unneeded because the drug is very safe describes the opposite, a wide therapeutic index. Doubling the next dose if one dose is missed risks toxicity. Giving it only by the oral route has nothing to do with the therapeutic index.
Category: Pharmacodynamics
Question 7
Which drug characteristic helps a drug cross the blood-brain barrier?
Large molecular size
High protein binding
High lipid solubility
✓
High water solubility
Correct Answer
High lipid solubility
Lipid-soluble drugs pass through cell membranes and the blood-brain barrier readily, which is why many sedatives and anticonvulsants reach the brain. Large molecular size slows passage across membranes. High protein binding keeps more drug in the blood and out of the brain. High water solubility makes crossing the lipid membranes of the barrier harder.
Category: Pharmacokinetics
Question 8
Before giving a drug that is excreted mainly by the kidneys, which laboratory values should the nurse review?
AST and ALT
Hemoglobin and hematocrit
Platelets and INR
BUN and serum creatinine
✓
Correct Answer
BUN and serum creatinine
BUN and serum creatinine reflect kidney function, and impaired kidneys can let a renally excreted drug accumulate, so the dose may need adjustment. AST and ALT are liver enzymes that reflect hepatic function. Hemoglobin and hematocrit measure red blood cells and oxygen-carrying capacity. Platelets and INR assess clotting.
Category: Pharmacokinetics
Question 9
Which pair of identifiers meets the Joint Commission standard for confirming a client's identity before giving a medication?
Full name and date of birth
✓
Room number and bed number
Full name and room number
Diagnosis and date of birth
Correct Answer
Full name and date of birth
The Joint Commission requires at least two client-specific identifiers, such as full name and date of birth or medical record number, checked against the wristband and the medication record. Room number and bed number are locations, not identifiers, and clients move. Full name and room number still relies on a location. Diagnosis and date of birth uses a diagnosis, which many clients share.
Category: Medication Safety
Question 10
When should the nurse document that a medication was given?
Before preparing the dose
After the client receives the dose
✓
When the dose is removed from the cabinet
At the end of the shift
Correct Answer
After the client receives the dose
Administration is documented only after the client actually takes or receives the drug, so the record reflects what happened. Before preparing the dose risks recording a dose the client refuses or never receives. When the dose is removed from the cabinet has the same problem. At the end of the shift delays the record and invites errors such as a duplicate dose.
Category: Medication Safety
Question 11
Before giving scheduled metoprolol, the nurse finds a heart rate of 48/min and a blood pressure of 84/60 mm Hg, and the client reports dizziness. What should the nurse do?
Give the dose and recheck vital signs in an hour
Give half the dose
Withhold the dose and notify the provider
✓
Give the dose with a glass of water
Correct Answer
Withhold the dose and notify the provider
Metoprolol slows the heart rate and lowers blood pressure, so giving it to a client who is already bradycardic, hypotensive and dizzy could cause harm; the nurse withholds it, notifies the provider and reassesses. Give the dose and recheck vital signs in an hour worsens the problem before anyone acts. Give half the dose changes the order without authority. Give the dose with a glass of water ignores the unsafe findings.
Category: Nursing Process and Judgment
Question 12
Which medication is considered high alert, so that a second nurse should independently verify the dose before it is given?
Acetaminophen
Docusate
Loratadine
Heparin
✓
Correct Answer
Heparin
Heparin is a high-alert anticoagulant, because a dosing error can cause life-threatening bleeding, so a second nurse verifies the dose. Acetaminophen is a common analgesic that is not usually on high-alert double-check lists. Docusate is a stool softener with a low risk of serious harm. Loratadine is a non-sedating antihistamine with a wide margin of safety.
Category: Medication Safety
Question 13
In the NCSBN Clinical Judgment Measurement Model, which step involves observing signs, symptoms and other client data?
Recognize cues
✓
Generate solutions
Take action
Evaluate outcomes
Correct Answer
Recognize cues
Recognize cues is the first step and corresponds to assessment in the nursing process: noticing relevant signs, symptoms and data. Generate solutions means considering possible actions, including withholding a drug. Take action means carrying out the chosen interventions. Evaluate outcomes means judging whether the goals were met.
Category: Nursing Process and Judgment
Question 14
A nurse has a client practice drawing up and self-injecting a medication under supervision. Which learning domain does this address?
Cognitive
Psychomotor
✓
Affective
Social
Correct Answer
Psychomotor
The psychomotor domain covers physical skills learned by doing, such as preparing and giving an injection. Cognitive covers knowledge and understanding, such as how the drug works. Affective covers feelings, beliefs and attitudes, such as fear of needles. Social is not one of the three learning domains used in client teaching.
Category: Client Education
Question 15
Which method lets the nurse confirm that a client understood medication teaching?
Asking whether the client has any questions
Handing the client a printed pamphlet
Having the client explain the plan in their own words
✓
Repeating the instructions more slowly
Correct Answer
Having the client explain the plan in their own words
Teach-back, in which the client restates the instructions in their own words, shows the nurse what the client actually understood and what needs clarifying. Asking whether the client has any questions often gets a simple no without revealing gaps. Handing the client a printed pamphlet provides information but does not check understanding. Repeating the instructions more slowly is still one-way teaching.
Category: Client Education
Question 16
Why does the nurse draw medication from a glass ampule through a filter needle?
To speed up withdrawal of the drug
To sterilize the medication
To mix the medication with air
To keep glass fragments out of the syringe
✓
Correct Answer
To keep glass fragments out of the syringe
Snapping an ampule open can leave tiny glass fragments in the fluid, and a filter needle traps them; it is then replaced with a new needle, because injecting through it could push glass into the client. To speed up withdrawal of the drug is incorrect, since a filter slows the draw. To sterilize the medication is incorrect, because the drug is already sterile. To mix the medication with air is incorrect, and air is never injected into an ampule.
Category: Routes and Techniques
Question 17
Why does a sublingual drug such as nitroglycerin act rapidly?
It is absorbed through vascular tissue and avoids first-pass metabolism
✓
It is swallowed and absorbed in the stomach
It dissolves slowly in the small intestine
It is stored in fat and released gradually
Correct Answer
It is absorbed through vascular tissue and avoids first-pass metabolism
The tissue under the tongue is highly vascular, so a sublingual drug enters the bloodstream quickly and bypasses the liver on its first pass. It is swallowed and absorbed in the stomach describes an oral drug, which a sublingual tablet is not. It dissolves slowly in the small intestine would delay the effect. It is stored in fat and released gradually describes a slow, prolonged pattern, not rapid action.
Category: Routes and Techniques
Question 18
A provider orders furosemide 60 mg. The vial is labeled 20 mg/2 mL. How many milliliters should the nurse draw up?
3 mL
6 mL
✓
12 mL
0.6 mL
Correct Answer
6 mL
Using desired over have times quantity, 60 mg divided by 20 mg equals 3, and 3 times 2 mL equals 6 mL. 3 mL results from forgetting to multiply by the 2 mL volume. 12 mL results from multiplying by 2 twice. 0.6 mL results from misplacing the decimal point.
Category: Dosage Calculations
Question 19
A child who weighs 44 lb is prescribed a drug at 10 mg/kg per dose. Using 2.2 lb = 1 kg, how many milligrams is one dose?
440 mg
20 mg
200 mg
✓
968 mg
Correct Answer
200 mg
First convert weight: 44 lb divided by 2.2 equals 20 kg; then 20 kg times 10 mg/kg equals 200 mg. 440 mg results from using the weight in pounds without converting. 20 mg is the weight in kilograms, not the dose. 968 mg results from multiplying pounds by 2.2 instead of dividing.
Category: Dosage Calculations
Question 20
Which intramuscular injection technique keeps an irritating or staining drug such as iron from leaking back into the subcutaneous tissue?
Intradermal injection
Massaging the site afterward
Aspirating before injecting
Z-track method
✓
Correct Answer
Z-track method
In the Z-track method the skin is pulled to one side before the needle is inserted and released after it is withdrawn, which seals the needle track and traps the drug in the muscle. Intradermal injection places a small amount of drug into the dermis and is not used for iron. Massaging the site afterward could push the drug into surrounding tissue. Aspirating before injecting checks for blood return but does not seal the track.
Category: Routes and Techniques