Focus on Nursing Pharmacology Karch 5th Edition Test Bank

Focus on Nursing Pharmacology Karch 5th Edition

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1. A nurse is preparing a drug for administration to a patient. The drug does not have an
indicated use for the patient's medical diagnosis. What should the nurse do?
A) Administer the drug as ordered.
B) Question the prescriber concerning the ordered drug.
C) Ask a coworker his or her thoughts about the ordered drug for the patient.
D) Ask the patient why the drug has been prescribed for him or her.
Ans: B
Feedback:
If the nurse is not sure about giving a drug, the order should be questioned. The nurse
should never give a medication that is not clear. Mistakes do happen and the drug
ordered, if not approved for the condition that the patient has, could be an error on
someone's part. The person who wrote the order should be questioned, not a co worker,
who probably does not know why an off-label drug is being used. It would be
unprofessional and inappropriate to ask the patient about the drug.

2. According to Center for Disease Control and Prevention (CDC) recommendations, what
is the role of the nurse in preparing for the possibility of bioterrorism?
A) Post updated information on signs and symptoms of infections caused by
biological agents
B) Provide guidelines for treating patients exposed to, or potentially exposed to,
biological agents
C) Remain current on recognition and treatment of infections caused by biological
weapons
D) Advocate for increased funding for research involving bioterrorism and patient
treatment
Ans: C
Feedback:
Nurses need to remain current about recognition of and treatment for those exposed to
biological weapons because nurses are often called upon to answer questions, reassure
the public, offer educational programs, and serve on emergency preparedness
committees. The CDC posts updated information on signs and symptoms of infections
caused by biological agents that nurses would read. The CDC also provides guidelines
for how to treat patients exposed to biological agents and the nurse must remain current
on this information. Although nurses could advocate for funding, this is not usually the
role of the nurse.

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3. How can the nurse find the most up-to-date information about emergency preparedness
related to bioterrorism agents?
A) Read textbooks devoted to the topic.
B) Ask coworkers to explain current events.
C) Read journal articles about bioterrorism agents.
D) Visit the Centers for Disease Control and Prevention (CDC) Web site.
Ans: D
Feedback:
The most current information will be found on the CDC Web site because new
information can be posted immediately whereas textbooks and journal articles take time
to print. Coworkers may or may not remain current on emergency preparedness and
should not be the primary source of information.

4. The nurse is assessing a diabetic patient who has presented at the clinic reporting several
hypoglycemic episodes during the past 3 weeks. The nurse questions the patient about
the use of herbal or alternative therapies, suspecting what herbal remedy could cause the
hypoglycemic episodes?
A) St. John's wort
B) Kava
C) Fish oil
D) Ginseng
Ans: D
Feedback:
Ginseng is known to decrease blood sugar levels. If the patient used this in combination
with his or her oral antidiabetic agent, diet, and exercise, his or her blood sugar could
drop below therapeutic levels. St. John's wort interacts with many drugs, but not with
antidiabetic agents. Kava is associated with liver toxicity. Fish oil has been associated
with decreased coronary artery disease.

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5. A 22-year-old patient calls the clinic and tells the nurse that she has been depressed and
is thinking about taking St. John's wort but wants to know if it is safe first. The nurse
begins by questioning what other medications the patient takes and would be concerned
about a drug-alternative drug interaction if the patient is also taking what type of
medication?
A) Antihistamines
B) Analgesics
C) Antibiotics
D) Oral contraceptives
Ans: D
Feedback:
St. John's wort can interact with oral contraceptives that alter drug metabolism, which
can decrease the effectiveness of the contraceptive. Analgesics, antibiotics, and
antihistamines can be taken in combination with St. John's wort without known adverse
effects.

6. A patient tells the clinic nurse that he or she has been taking over-the-counter (OTC)
Pepcid to relieve acid indigestion for several years. This is the first time the patient has
ever reported this issue to a health care provider. As part of the teaching plan for this
patient, the nurse explains what risk associated with not sharing OTC drug use with the
provider?
A) The OTC drug could be more expensive than seeking health care advice.
B) The drug could mask symptoms of a serious problem that is undiagnosed.
C) Use of the drug could cause a rebound effect of Pepcid.
D) The drug could interact with several cold medicines.
Ans: D
Feedback:
OTC drugs allow patients to self-diagnose and treat routine signs and symptoms without
seeing a health care provider. This self-prescribed treatment, however, could mask a
more serious underlying medical problem and result in a poor outcome for the patient.
The issues of drug rebound and drug interaction need to be considered, but the safety
issue related to self-diagnosis and self-prescription presents the greatest risk to the
patient. Patients should always be encouraged to discuss the use of OTC products with
their health care provider.

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7. What patient populations would the nurse expect is most likely to be prescribed a drug
for an off-label use?
A) Adolescent and middle-aged adult patients
B) Patients with diabetes or heart disease
C) Obstetric and neonatal patients
D) Pediatric and geriatric patients
Ans: D
Feedback:
Drugs being used for an off-label purpose are commonly prescribed for pediatric and
geriatric populations due to the lack of drug trial information and minimal premarket
testing. Often a trial-and-error method is used in treating both the pediatric and geriatric
populations when only adult information is known. The geriatric population responds to
medication more like children because of their decreased ability to metabolize
medications. Adolescents, especially later adolescents, use medications similarly to
young adults as do middle-aged adults. Patients with different diagnoses are often
involved in drug testing including those with diabetes and heart disease. Drugs are
discouraged for use in obstetric patients.

8. A patient calls the clinic and asks to speak to a nurse. The patient questions the nurse
about the use of a drug that was advertised on TV. The patient tells the nurse he or she is
sure that the drug will make him or her feel the same way as described in the
commercial. What response is most appropriate for the nurse to make?
A) “I'm glad that you want to be involved in treatment decisions but you are not
qualified to decide what medications are best for your condition.”
B) “It's important to remember that drug advertisements emphasize the positive
effects of drug therapy and not the adverse effects or contraindications.”
C) “You need to remember that the drugs being advertised are much more expensive
than other drugs that have the same effect.”
D) “I've seen those advertisements and I would want to take that medication too if I
had the condition it was designed to treat.”
Ans: B
Feedback:
It would be important for the nurse to remind the patient that advertisements always
emphasize the positive effects of drug therapy. The patient should not be discouraged
from contributing to the plan of care by being told she is not adequately qualified to
make decisions because no one is more qualified to make decisions about her own body.
Although the drug may be more expensive, this is not a reason to choose or avoid a
medication that could be more effective. Agreeing with the patient is not meeting the
nurse's obligation to teach and inform.

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 9. The clinic nurse is talking with a patient about information concerning a drug her or she
bought online. What is the nurse's responsibility to the patient concerning this
information?
A) Encourage the patient to seek information about drugs from a pharmacist.
B) Explain that information obtained from the Internet is not always accurate.
C) Offer the patient a drug reference guide to read and learn more about the drug.
D) Interpret the information and explain it in terms that the patient will understand.
Ans: D
Feedback:
The Internet can be a good reference for drug information. However, the amount and
reliability of the information can be overwhelming. The nurse should always try to
interpret the information and explain it in terms that the patient will understand. A
pharmacist is a good resource person but may not be able to teach from a holistic
perspective. Drug reference guides may be hard for the patient to understand and he or
she would still need someone to interpret the information.

10. The triage nurse in the emergency department sees a patient suspected of abusing
amphetamines brought in by friends. While assessing this patient, what would the nurse
be likely to find if steroids are being abused?
A) Hypertension
B) Bradycardia
C) Drowsiness
D) Elated mood
Ans: A
Feedback:
Increases in blood pressure, tachycardia, and insomnia are symptoms of amphetamine
abuse. Elation can indicate abuse of cannabis.

11. The nursing instructor is discussing the off-label use of drugs. What group of drugs
would the instructor tell the nursing students is often used for off-label indications?
A) Drugs used to treat psychiatric problems
B) Drugs used to treat gastrointestinal (GI) problems
C) Drugs used to treat cardiovascular problems
D) Drugs used to treat musculoskeletal problems
Ans: A
Feedback:
Drugs often used for off-label indications include the drugs used to treat various
psychiatric problems. Drugs used to treat GI, cardiovascular, or musculoskeletal
problems do not fall in the category of frequent off-label uses.

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12. The patient calls the clinic nurse and says, “I looked this medication up on the Internet
after it was prescribed yesterday and there is nothing in the literature about this drug
being used to treat my disorder. Should I still take it?” What is the nurse's best
response?
A) “No, stop taking it immediately until I can consult with the doctor because it is
obvious a mistake was made.”
B) “Oh, that's okay. Go ahead and take it because the doctor wouldn't order it if he or
she didn't think it would be effective.”
C) “It is quite common for drugs to be found to have positive effects for a condition
not originally intended so it is safe to take.”
D) “Let me talk with the physician about why this medication was ordered for you
and I will call you back.”
Ans: D
Feedback:
Off-label use is relatively common because new information is gathered when the drug
is used by large numbers of people that may indicate another condition for which the
drug is effective. However, if the nurse does not know for a fact that the drug prescribed
is the right drug for the patient's condition, it is always best to consult with the
prescriber to make sure the patient is taking the right drug and to avoid a medication
error. The medication may be perfectly safe so the patient should not be told the doctor
made a mistake.

13. When a drug is ordered off-label, what must the nurse be clear about before
administering the drug? (Select all that apply.)
A) Why the drug is being given
B) Its potential for problems
C) The research that has been done
D) The age group it was pretested on
E) The intended use
Ans: A, B, E
Feedback:
Liability issues surrounding many of these uses are very unclear, and the nurse should
be clear about the intended use, why the drug is being given, and its potential for
problems. Knowing the age group it was pretested on and knowing the research that has
been done are not factors the nurse needs to know before administering the drug.

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14. It is important for the nurse to be aware of what related to the way drugs are marketed?
A) The adverse effects the advertisements do not mention
B) What magazines and Web sites contain the advertisement
C) What patients are seeing in the advertisements about these drugs
D) The name of the cheerful, happy models who are advertising these drugs
Ans: C
Feedback:
As the marketing power for prescription drugs continues to grow, the nurse must be
constantly aware of what patients are seeing, what the ads are claiming, and the real data
behind the indications and contraindications for these “hot” drugs. The Food and Drug
Administration regulates the information that needs to be contained within medication
ads. Where the patient saw the ad and the actors in the ads are unimportant.

15. When evaluating information accessed over the Internet, an important question the nurse
should teach the patient to ask is what?
A) Is the information anecdotal?
B) Where has this information been obtained?
C) Is this information paid for by the drug company?
D) How many patients have had input into the information?
Ans: A
Feedback:
Many people do not know how to evaluate the drug-related information that they can
access over the Internet. Is it accurate or anecdotal is an important concept for the nurse
to teach the patient to assess to verify the accuracy of the information. Where the
information came from is unimportant. It would be expected that all drug advertising is
paid for by the drug company and this is not an important concern. Number of patients
with input into the information is most likely none because information is gathered from
health care professionals.

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16. How has the patient's access to drug information changed the way the patient interacts
with the nurse and other health care providers?
A) Patients share information from research reports with health care providers.
B) Patients are contacting drug companies to see what their latest reports say.
C) Patients are more likely to challenge the health care provider with their own
research.
D) Patients are more likely to self-prescribe and not obtain prescriptions from their
health care provider.
Ans: C
Feedback:
Access to consumer advertising, mass media health reports, and the Internet influence
some patients to request specific treatments, to question therapy, and to challenge the
health care provider. Consumers do not generally read research reports from medical
facilities and contact drug companies to see what their reports say, and they cannot
self-medicate because many of these drugs require a prescription to obtain them.

17. What can make a nurse or any health care provider lose credibility with the patient?
A) Being unprepared to deal with “the disease of the week”
B) Refusing to write prescriptions for the drug the patient requests
C) Not being knowledgeable about diseases described on House
D) Being prepared to discuss the role of “concierge” doctor
Ans: A
Feedback:
Some health care providers have learned to deal with the “disease of the week” as seen
on talk shows; others can be unprepared to deal with what was presented and may lose
credibility with the patient.

18. Today, an abundance of information is available in the health care arena for consumers,
resulting in the nurse encountering patients who have a much greater use of what?
A) Over-the-counter (OTC) therapies
B) Alternative therapies
C) Prescription drugs
D) Off-label drugs
Ans: B
Feedback:
The patient now comes into the health care system burdened with the influence of
advertising, the Internet, and a growing alternative therapy industry. Many patients no
longer calmly accept whatever medication is selected for them. Indeed, an increasing
number of patients are turning to alternative therapies with the belief that they will treat
their disorder and reduce risk of adverse effects. Although more prescription drugs are
used today, that is not related to abundant information. No indication exists of an
increase in use of OTC or off-label drugs.

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19. Because of the amount of care now being done in the home care setting, it is imperative
that the nurse teach the patients what? (Select all that apply.)
A) Care givers’ educational level.
B) Generic names of medication
C) Over-the-counter (OTC) drugs that need to be avoided
D) Alleviation of adverse effects
E) How to calculate safe dosages
Ans: B, C, D
Feedback:
The responsibility of meeting the tremendous increase in teaching needs of patients
frequently resides with the nurse. Patients need to know exactly what medications they
are taking (generic and brand names), the dose of each medication, and what each is
supposed to do. Patients also need to know what they can do to alleviate some of the
adverse effects that are expected with each drug (e.g., small meals if gastrointestinal
upset is common, use of a humidifier if secretions will be dried and make breathing
difficult), which OTC drugs or alternative therapies they need to avoid while taking
their prescribed drugs, and what to watch for that would indicate a need to call the
health care provider.

20. What concerns might the nurse legitimately have related to the use of alternative
therapies? (Select all that apply.)
A) The Food and Drug Administration (FDA) does not test or regulate active
ingredients.
B) The incidental ingredients are clearly marked on the label.
C) The dosage contained in each tablet may vary greatly.
D) No alternative therapies have been found to be effective.
E) Advertising of alternative products is not as restrictive or accurate.
Ans: A, C, E
Feedback:
Alternative products are not controlled or tested by the FDA and advertising is not as
restrictive or accurate as with classic drugs. Incidental ingredients are often unknown
and strength of tablets may vary within the bottle depending on the conditions under
which they were grown. While some alternative therapies have been found to be
effective, there are others who have not been studied.

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21. The nurse provides teaching to the patient using herbal therapies and includes what
important information related to the effects of the herbal therapy?
A) They can interact with prescription drugs.
B) They always contain known ingredients.
C) They are natural so they are effective and safe.
D) The ingredients are natural, meaning toxicity is not a concern.
Ans: A
Feedback:
Herbal therapies can produce unexpected adverse effects and toxic reactions, can
interact with prescription drugs, and can contain various unknown ingredients that alter
the therapies' effectiveness and toxicity.

22. When patients do not understand the information provided with their medication, whose
responsibility is it to help them sort through and comprehend the meaning?
A) Care giver
B) Nurse
C) Patient
D) Physician
Ans: B
Feedback:
Many pharmacies provide written information with each drug that is dispensed, but
trying to organize these sheets of information into a usable and understandable form is
difficult for many patients. The nurse is often the one who needs to sort through the
provided information to organize, simplify, and make sense of it for the patient.

23. The nurse is providing an inservice on alternative therapies for peers and explains that
the term “alternative therapies” includes what?
A) Holistic drug therapy
B) Hospice care
C) Nondrug measures
D) Home care
Ans: C
Feedback:
Herbal medicines and alternative therapies are found in ancient records and have often
been the basis for discovery of an active ingredient that is later developed into a
regulated medication. Today, alternative therapies can also include non-drug measures,
such as imaging and relaxation. Options A, B, and D are not included in alternative
therapies.

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24. The patient calls the clinic and talks to the nurse saying, “I found the same drug the
provider prescribed on the Internet and it is much cheaper. Is it safe for me to order my
drug from this site?” What is the nurse's best response?
A) “It is usually safe to order drugs from Internet Web sites if it is a reliable site.”
B) “Most drugs ordered online come from another country and are safely used there.”
C) “The drug you get will be the same chemical prescribed but the dosage may
differ.”
D) “The Food and Drug Administration (FDA) has issued warnings to consumers
about the risk of taking unregulated drugs.”
Ans: D
Feedback:
The FDA has begun checking these drugs when they arrive in this country and have
found many discrepancies between what was ordered and what is in the product, as well
as problems in the storage of these products. Some foreign brand names are the same as
brand names in this country but are associated with different generic drugs. The FDA
has issued many warnings to consumers about the risk of taking some of these drugs
without medical supervision, reminding consumers that they are not protected by U.S.
laws or regulations when they purchase drugs from other countries.

25. With the need to protect our environment, what is it now important for the nurse to
teach patients to do?
A) Dispose of drugs no longer used on an annual basis.
B) Flush drugs down the toilet.
C) Bury unused in the yard.
D) Throw unused pill bottles in the trash in original containers.
Ans: A
Feedback:
Patients should go through their medicine cabinet annually and dispose of drugs no
longer used. Unused drugs should not be flushed down the toilet or buried in the yard
because they seep into the community water supply. Pills should be removed from their
bottle and mixed with an undesirable substance to prevent someone from using the
medication if found.

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26. The nurse receives a call from a frantic mother saying, “My child swallowed some of
my birth control pills. Should I give Ipecac?” What is the nurse's best response?
A) “Yes, give Ipecac and follow the dosage directions on the bottle.”
B) “Ipecac is not effective for this use so you should not give it to your child.”
C) “Give the Ipecac only if you are absolutely sure your child swallowed the pills.”
D) “No, don't give Ipecac because it will cause your child to vomit and make a
mess.”
Ans: B
Feedback:
Ipecac is a drug that the Food and Drug Administration tested in 2003 and found,
despite its use for many years, that it was not effective in inducing vomiting in children
suspected of poisoning. As a result, it is no longer used. The mother should be instructed
not to give it and to call poison control to get up-to-date instructions on how to deal with
this emergency. Whether the pills were swallowed, this child requires appropriate
intervention because it is better to err on the side of caution. Making a mess is not a
concern.

27. The patient tells the nurse that he or she has begun ordering his or her medications over
the Internet because it is cheaper. What statement made by the nurse in response to this
information is accurate?
A) All drugs are manufactured with the same quality controls.
B) Any drug that is shipped into this country is safe to use.
C) Foreign drugs may have the same name as domestic drugs, but they are not the
same drug.
D) If you order from Canada or Mexico, the drugs are safe because they undergo
testing.
Ans: C
Feedback:
The Food and Drug Administration has begun checking these drugs when they arrive in
this country and have found many discrepancies between what was ordered and what is
in the product, as well as problems in the storage of these products. Some foreign brand
names are the same as brand names in this country but are associated with different
generic drugs. Options A, B, and D are incorrect because not all drugs are manufactured
the same and they are not always safe coming from another country.

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28. The increasing number of patients who go to their health care provider and request a
drug they have seen advertised on television or in a magazine has created what
continuing challenge to health care providers?
A) Treating infections appropriately
B) Treating sicker patients
C) Prescribing cost-effectively
D) Staying knowledgeable about drug therapy
Ans: D
Feedback:
As the marketing power for prescription drugs continues to grow, the health care
provider must be constantly aware of what patients are seeing (or reading), what the
commercials and ads are promising, and the real data behind the indications and
contraindications for these “hot” drugs. It is a continuing challenge to stay up-to-date
and knowledgeable about drug therapy.

29. Ipecac, formerly used as the drug of choice by parents for treatment of suspected
poisoning in children, was tested by the Food and Drug Administration (FDA) in 2003.
What was the finding of this testing?
A) Ipecac is ineffective for its intended use.
B) Ipecac is the safest treatment for poisoning in children.
C) Ipecac was “grandfathered” in as an ineffective drug.
D) Ipecac induces vomiting.
Ans: A
Feedback:
Ipecac, a formerly standard over-the-counter drug, was used for many years by parents
to induce vomiting in children in cases of suspected poisoning or suspected drug
overdose. The drug was finally tested and in 2003, the FDA announced that it was not
found to be effective for its intended use. Although it was grandfathered in as an
effective drug, this was not what the study researched. Ipecac is not effective and does
not consistently induce vomiting.

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30. Federal guidelines state that when advertising a drug, if the company states what the
drug is used for, what other information must also be included in the advertisement?
(Select all that apply.)
A) Symptoms
B) Contraindications
C) Adverse effects
D) Precautions
E) Cost
Ans: B, C, D
Feedback:
If a drug advertisement states what the drug is used for, it must also state
contraindications, adverse effects, and precautions. The advertisement does not have to
state symptoms or cost.

31. The parent of a 2-year-old child is visiting his or her pediatric health care provider and
shows the nurse the advertisement for allergy medication found in a magazine in the
waiting room saying, “This drug sounds like it would be far more effective to treat my
son's asthma and I'd only have to give it once a day.” What is the nurse's best response?
A) “Talk with your health care provider about this drug, but be aware that
advertisements do not always provide all the important information you need to
know.”
B) “Oh, I need to throw that magazine away because so many people show me that
ad and it is all complete nonsense with no truth to it at all.”
C) “I've been seeing amazingly positive results from that medication so you are
absolutely right to want to give it to your child.”
D) “That drug is dangerous and should not be given to children under the age of 5
unless there are no other good options.”
Ans: A
Feedback:
The health care provider should make the decision about what medications are to be
prescribed, not the nurse. However, the nurse can make the mother aware of the fact that
there is often more that goes into choosing the correct drug than the bit of information
disclosed in the advertisement. Becoming upset with the mother, agreeing with the
mother, or frightening the mother about the medication is the wrong approach for the
nurse to use.

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32. The local news has been discussing a specific rare disorder that killed a child in the
community this week, describing the symptoms of the disease as including nasal
congestion, ear pain, and a cough. The pediatrician's office is receiving numerous calls
asking to make appointments to rule out this rare disease. What is the nurse's best
action?
A) Prepare a handout that describes the disorder discussed in the news in greater
detail.
B) Tell parents their child is experiencing the common cold and do not need to be
seen.
C) Direct all calls to the local news agency to answer questions and provide details.
D) Become familiar with the disorder and screen each call for more specific
symptoms.
Ans: A
Feedback:
The nurse needs to not only become more familiar with the disorder in the news, but
also needs to be prepared to teach parents about the “disease of the week” to allay fears
so a handout with detailed information would allow the parents to have something to
consult after leaving the provider's office. Turning parents away without seeing their
child will increase fears and the office will lose credibility for lack of interest in their
child's well-being. Directing calls to the news agencies will not provide parents with
essential information. Screening calls without seeing the child could be potentially very
dangerous.

33. The nurse is teaching the patient how to safely use the Internet for health information
and includes what information in the teaching plan?
A) The Web site where information is obtained needs to be evaluated for credibility.
B) Most information found on the Internet is accurate.
C) Information on the Internet is most reliable when people give their reviews of the
drug.
D) Only a health care professional can tell whether a Web site is reliable.
Ans: A
Feedback:
There are excellent sites for reliable drug information, but each site must be evaluated
for credibility and the nurse can teach the patient things to look for to increase
confidence in the site. However, a lot of information on the Internet is not accurate; the
patient needs to learn how to recognize unreliable information when he or she comes
across these sites. Just because a person reviews a drug and gives it multiple stars or a
thumbs up does not mean the drug is any more effective or useful in the patient's care.

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Focus on Nursing Pharmacology Karch 5th Edition Test Bank

34. The nursing instructor is teaching the class about how prescription drugs become
over-the-counter (OTC) drugs and lists what factor as preventing a drug from becoming
classified as OTC?
A) If the patient cannot reliably self-diagnose the condition the drug is intended to
treat
B) If it would mask signs and symptoms of an underlying problem, the drug remains
available by prescription only.
C) If the drug would cause toxic effects if not taken as directed, it remains a
prescription drug.
D) OTC drugs must not have any adverse effects that could harm the patient.
Ans: A
Feedback:
If a diagnosis requires medical intervention, such as hyperlipidemia, which can only be
diagnosed through laboratory studies, there is no point in making the drug an OTC
medication. Most, if not all, OTC drugs have the capacity to mask signs and symptoms
of an underlying disease so this is not a factor in deciding if a drug can be sold OTC. All
drugs have the potential for toxic effects if not taken as directed and virtually all drugs
have the potential for adverse effects.

35. The nurse needs to ask what specific questions when collecting a drug history? (Select
all that apply.)
A) “Do you take any over-the-counter medications?”
B) “Do you take any herbal supplements?”
C) “Do you use any alternative therapies?”
D) “Do you take any natural supplements or vitamins?”
E) “What unusual therapies do you take?”
Ans: A, B, D
Feedback:
The nurse needs to specifically question the patient's use of over-the-counter drugs,
herbal supplements, natural supplements, and vitamins. Use of terms like “alternative
therapies” or “unusual therapies” is too vague and may not elicit the kind of information
needed.

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