Rosenthal: Lehne's
Pharmacotherapeutics for Advanced
Practice Providers, 1st Ed. Chapter 1:
Prescriptive Authority
1. . A 11-year-old boy received all childhood immunizations before attending school as
a kindergartner. Which vaccines are recommended for this child at his current age?
2. a. DTaP, MCV4, Varivax
3. b. PCV-23, Td, MMR
4. c. Tdap, MCV4, HPV
5. d. Tdap, Varivax, hepatitis B - ANS-ANS: C
6. At age 11, both males and females should receive a booster of diphtheria, tetanus,
and pertussis (Tdap); the Menactra vaccine against meningitis (MCV4); and the
human papillomavirus (HPV) vaccine. A Varivax booster is not recommended at this
age. The PCV-23 vaccine is indicated only in high-risk patients. The Tdap can be
given, but a vaccine with a pertussis component is preferred. The MMR is not given
at this age. The hepatitis B vaccine is not given at this age.DIF: Cognitive Level:
ApplicationREF: p. 583TOP: Nursing Process: Implementation MSC: NCLEX Client
Needs Category: Physiologic Integrity: Health Promotion and Maintenance
7. . A nurse is reviewing an older adult patient's chart before giving medications. Which
patient information is of most concern?
8. a. Chronic constipation
9. b. Increased body fat
10. c. Low serum albumin
11. d. Low serum creatinine - ANS-ANS: C
12. Low serum albumin reduces protein binding of drugs and can cause levels of free
drug to rise, increasing the risk of toxicity. Altered gastrointestinal (GI) absorption is
not a major factor in drug sensitivity in the older adult, although delayed gastric
emptying can delay drug responses. Increased body fat can alter drug distribution,
causing reduced responses in lipid-soluble drugs, however, it is not the finding of
greatest concern to the nurse. Low serum creatinine is a function of decreased lean
muscle mass in older patients and does not reflect kidney function or drug
excretion.DIF: Cognitive Level: ApplicationREF: p. 69TOP: Nursing Process:
Diagnosis MSC: NCLEX Client Needs Category: Physiologic Integrity: Physiologic
Adaptation
13. 2. A child will receive 750 mg of an antibiotic for 10 days. The child attends day care.
The drug may be dosed in several ways and is available in two concentrations.
Which dosing regimen will the nurse discuss with the child's provider?
14. a. 250 mg/5 mL to 375 mg PO twice daily
15. b. 250 mg/5 mL to 250 mg PO three times daily
,16. c. 500 mg/5 mL to 250 mg PO three times daily
17. d. 500 mg/5 mL to 375 mg PO twice daily - ANS-ANS: D
18. To promote adherence to a drug regimen in children, it is important to consider the
size and timing of the dose. In this case the preparation containing 500 mg/5 mL
means that a smaller volume can be given, which is more palatable to a child. Twice
daily dosing is more convenient for parents, especially when a child is in day care or
school; it also helps prevent the problem of the medication being left either at home
or at school.DIF: Cognitive Level: ApplicationREF: p. 68TOP: Nursing Process:
Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity:
Reduction of Risk Potential
19. 3. Parents ask the nurse why an over-the-counter cough suppressant with sedative
side effects is not recommended for infants. Which response by the nurse is correct?
20. a. "Babies have a more rapid gastric emptying time and do not absorb drugs well."
21. b. "Cough medicine tastes bad, and infants usually won't take it."
22. c. "Infants are more susceptible to central nervous system effects than are adults."
23. d. "Infants metabolize drugs too rapidly, so drugs are not as effective." - ANS-ANS: C
24. Drugs cross the blood-brain barrier more readily in infants, making these patients
more susceptible to central nervous system (CNS) side effects. Infants have a
prolonged and irregular gastric emptying time and absorb drugs in the stomach more
quickly. Although it may be true that cough medicines taste bad and are difficult to
administer, this is not a contraindication to giving them. Infants metabolize drugs
more slowly.DIF: Cognitive Level: AnalysisREF: p. 66TOP: Nursing Process:
Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity:
Reduction of Risk Potential
25. 31. A patient reports becoming "immune" to a medication because it no longer works
to alleviate symptoms. The nurse recognizes that this decreased effectiveness is
likely caused by:
26. a. antagonists produced by the body that compete with the drug for receptor sites.
27. b. decreased selectivity of receptor sites, resulting in a variety of effects.
28. c. desensitization of receptor sites by continual exposure to the drug.
29. d. synthesis of more receptor sites in response to the medication. - ANS-ANS: C
30. Continual exposure to an agonist would cause the cell to become less responsive or
desensitized. The body does not produce antagonists as a response to a medication.
Receptor site selectivity is determined by physiologic factors and not by the
substances that bind to them. Medications do not cause more receptors to be
produced.DIF: Cognitive Level: AnalysisREF: p. 32-33TOP: Nursing Process:
Diagnosis MSC: NCLEX Client Needs Category: Physiologic Integrity: Pharmacologic
and Parenteral Therapies
31. 32. A patient who is taking morphine for pain asks the nurse how a pain medication
can also cause constipation. What does the nurse know about morphine?
32. a. It binds to different types of receptors in the body.
33. b. It can cause constipation in toxic doses.
34. c. It causes only one type of response, and the constipation is coincidental.
35. d. It is selective to receptors that regulate more than one body process. - ANS-ANS:
D
36. Morphine is a medication that is selective to receptor type that regulates more than
one process. Because it is selective to receptor type, it does not bind to different
types of receptors. Constipation is a normal side effect and is not significant for
, toxicity.DIF: Cognitive Level: AnalysisREF: p. 35TOP: Nursing Process:
Implementation MSC: NCLEX Client Needs Category: Physiologic Integrity:
Pharmacologic and Parenteral Therapies
37. 33.The nurse is administering morning medications. The nurse gives a patient
multiple medications, two of which compete for plasma albumin receptor sites. As a
result of this concurrent administration, the nurse can anticipate that what might
occur?Select all that apply.
38. a. Binding of one or both agents will be reduced.
39. b. Plasma levels of free drug will rise.
40. c. Plasma levels of free drug will fall.
41. d. The increase in free drug will intensify effects.
42. e. The increase in bound drug will intensify effects - ANS-ANS: A,B,D
43. When two drugs bind to the same site on plasma albumin, co administration of those
drugs produces competition for binding. As a result, binding of one or both agents is
reduced, causing plasma levels of free drug to rise. The increase in free drug can
intensify the effect, but it usually undergoes rapid elimination. The increase in plasma
levels of free drug is rarely sustained.DIF: Cognitive Level: AnalysisREF: p. 36TOP:
Nursing Process: Diagnosis MSC: NCLEX Client Needs Category: Physiologic
Integrity: Pharmacologic and Parenteral Therapies
44. 34. When administering medications to infants, it is important to remember which of
the following?
45. Select all that apply.
46. a. Breast-feeding infants are more likely to develop toxicity when given lipid-soluble
drugs.
47. b. Immaturity of renal function in infancy causes infants to excrete drugs less
efficiently.
48. c. Infants have immature livers, which slows drug metabolism.
49. d. Infants are more sensitive to medications that act on the central nervous system
(CNS).
50. e. Oral medications are contraindicated in infants, because PO administration
requires a cooperative patient. - ANS-ANS: B,C,D
51. Immature renal function causes infants to excrete drugs more slowly, and infants are
at risk for toxicity until renal function is well developed. Infants' livers are not
completely developed, and they are less able to metabolize drugs efficiently.
Because the blood-brain barrier is not well developed in infants, caution must be
used when administering CNS drugs. Lipid-soluble drugs may be excreted in breast
milk if the mother is taking them, but breastfeeding does not affect medications given
directly to the infant. Oral medications may be given safely to infants as long as they
are awake and can swallow the drug.DIF: Cognitive Level: ComprehensionREF: "pp.
20,22,24"TOP: Nursing Process: Assessment MSC: NCLEX Client Needs Category:
Physiologic Integrity: Reduction of Risk Potential
52. 36. A nurse is preparing to administer a drug. Upon reading the medication guide, the
nurse notes that the drug has been linked to symptoms of Parkinson disease in some
patients. What will the nurse do?
53. a. Ask the patient to report these symptoms, which are known to be teratogenic
effects.
54. b. Observe the patient closely for such symptoms and prepare to treat them if
needed.
, 55. c. Request an order to evaluate the patient's genetic predisposition to this effect.
56. d. Warn the patient about these effects and provide reassurance that this is
expected. - ANS-ANS: B
57. A drug that causes disease-like symptoms is known to be iatrogenic. Nurses should
be prepared for this possibility and be prepared to withdraw the drug if necessary and
treat the symptoms. Such effects are not teratogenic, since teratogenic effects affect
the fetus. Patients with a genetic predisposition to respond differently to drugs are
known to have idiosyncratic effects. Iatrogenic effects, even when known, are not
typically expected side effects.DIF: Cognitive Level: ApplicationREF: pp. 41-42TOP:
Nursing Process: Diagnosis MSC: NCLEX Client Needs Category: Physiologic
Integrity: Pharmacologic and Parenteral Therapies
58. 37. Which patients are at increased risk for adverse drug events? Select all that
apply.
59. a. A 2-month-old infant taking a medication for gastroesophageal reflux disease
60. b. A 23-year-old female taking an antibiotic for the first time
61. c. A 40-year-old male who is intubated in the intensive care unit and taking antibiotics
and cardiac medications
62. d. A 7-year-old female receiving insulin for diabetes
63. e. An 80-year-old male taking medications for COPD - ANS-ANS: A,C,E
64. Patients at increased risk for adverse drug events include the very young, the very
old, and those who have serious illnesses. Females, children, and young adults
taking single medications do not have increased risk for adverse events.DIF:
Cognitive Level: AnalysisREF: "pp. 42,46"TOP: Nursing Process: Assessment MSC:
NCLEX Client Needs Category: Physiologic Integrity: Reduction of Risk Potential
65. 38. A nurse provides teaching to a patient who will begin taking a drug with a known
risk of hepatotoxicity. Which statement by the patient indicates a need for further
teaching?
66. a. "I should avoid taking acetaminophen while taking this drug."
67. b. "I will need periodic evaluation of aspartate aminotransferase and alanine
aminotransferase
68. levels."
69. c. "If I experience nausea, vomiting, or abdominal pain, I should call my provider."
70. d. "Routine testing and early detection of problems will prevent liver failure." -
ANS-ANS: D
71. Drug-induced liver injury can progress from undetectable to advanced between
routine tests; therefore, routine testing does not always prevent liver failure. Patients
taking known hepatotoxic drugs should avoid other drugs, such as acetaminophen,
that can cause liver damage. Aspartate aminotransferase (AST) and alanine
aminotransferase (ALT) are liver enzymes that are routinely monitored when a patient
is taking hepatotoxic drugs. Nausea, vomiting, and abdominal pain are signs of liver
injury and should be reported.DIF: Cognitive Level: ApplicationREF: p. 44TOP:
Nursing Process: Implementation MSC: NCLEX Client Needs Category: Physiologic
Integrity: Reduction of Risk Potential
72. 39. A nurse is reviewing a medication administration record before administering
medications. Which order will the nurse implement?
73. a. Furosemide [Lasix] 20 mg QD PO
74. b. Furosemide [Lasix] 20 mg qd PO
75. c. Furosemide [Lasix] 20 mg daily
