Chapter 02

Chapter 02: Basic Principles of Drug Action and Drug Interactions
Clayton/Willihnganz: Basic Pharmacology for Nurses, 17th Edition
MULTIPLE CHOICE
1. The nurse assesses hives in a patient started on a new medication. What is the
nurse’s priority action?
a. Notify physician of allergic reaction.

b. Notify physician of idiosyncratic reaction.
c. Notify physician of potential teratogenicity.
d. Notify physician of potential tolerance.
ANS: A
An allergic reaction is indicative of hypersensitivity and manifests with hives and/or
urticaria, which are easily identified. An idiosyncratic reaction occurs when something
unusual or abnormal happens when a drug is first administered. A teratogenic reaction
refers to the occurrence of birth defects related to administration of the drug. Tolerance
refers to the body’s requirement for increasing dosages to achieve the same effects that a
lower dose once did.
DIF: Cognitive Level: Application REF: Page 17 OBJ: 4

TOP: Nursing Process Step: Assessment
MSC: NCLEX Client Needs Category: Physiological Integrity
NOT: CONCEPT(S): Clinical Judgment; Safety
2. The nurse administers an initial dose of a steroid to a patient with asthma. Thirty
minutes after administration, the nurse finds the patient agitated and stating that
“everyone is out to get me.” What is the term for this unusual reaction?
a. Desired action
b. Adverse effect
c. Idiosyncratic reaction
d. Allergic reaction
ANS: C
Idiosyncratic reactions are unusual, abnormal reactions that occur when a drug is first
administered. Patients typically exhibit an overresponsiveness to a medication related to
diminished metabolism. These reactions are believed to be related to genetic enzyme
deficiencies. Desired actions are expected responses to a medication. Adverse effects are
reactions that occur in another system of the body; they are usually predictable. Allergic
reactions appear after repeated medication dosages.
DIF: Cognitive Level: Knowledge REF: Page 18 OBJ: 4

TOP: Nursing Process Step: Evaluation
NOT: CONCEPT(S): Patient Education; Clinical Judgment; Caregiving; Safety; Sensory
Perception
3. Which is the best description of when drug interactions occur?
a. On administration of toxic dosages of a drug

b. On an increase in the pharmacodynamics of bound drugs
c. On the alteration of the effect of one drug by another drug
d. On increase of drug excretion
ANS: C
Drug interactions may be characterized by an increase or decrease in the effectiveness of
one or both of the drugs. Toxicity of one drug may or may not affect the metabolism of
another one. Drug interactions may result from either increased or decreased
pharmacodynamics. Drug interactions may result from either increased or decreased
excretion.
DIF: Cognitive Level: Comprehension REF: Page 18 OBJ: 5

NOT: CONCEPT(S): Safety; Patient Education; Clinical Judgment
4. What occurs when two drugs compete for the same receptor site, resulting in
increased activity of the first drug?
a. Desired action
b. Synergistic effect
c. Carcinogenicity
d. Displacement
ANS: D
The displacement of the first drug from receptor sites by a second drug increases the
amount of the first drug because more unbound drug is available. An expected response
of a drug is the desired action. A synergistic effect is the effect of two drugs being greater
than the effect of each chemical individually or the sum of the individual effects.
Carcinogenicity is the ability of a drug to cause cells to mutate and become cancerous.

TOP: Nursing Process Step: Implementation
NOT: CONCEPT(S): Safety; Patient Education
5. What do drug blood levels indicate?
a. They confirm if the patient is taking a generic form of a drug.

b. They determine if the patient has sufficient body fat to metabolize the drug.
c. They verify if the patient is taking someone else’s medications.
d. They determine if the amount of drug in the body is in a therapeutic range.
ANS: D
The amount of drug present may vary over time and the blood level must remain in a
therapeutic range in order to obtain the desired result. Generic drugs do not necessarily
produce a different drug blood level than proprietary medications. Body fat is not
measured by drug blood levels. Drug blood levels only measure the amount of drug in the
body; they do not determine the source of the medication.

6. What is the process by which a drug is transported by circulating body fluids to

receptor sites?
a. Osmosis
b. Distribution
c. Absorption
d. Biotransformation
ANS: B
Distribution refers to the ways in which drugs are transported by the circulating body fluids
to the sites of action (receptors), metabolism, and excretion. Osmosis is the process of
moving solution across a semipermeable membrane to equalize the dilution on each side.
Absorption is the process by which a drug is transferred from its site of entry into the body
to the circulating fluids for distribution. Biotransformation, also called metabolism, is the
process by which the body inactivates drugs.

TOP: Nursing Process Step: Planning
NOT: CONCEPT(S): Patient Education; Clinical Judgment; Safety
7. The nurse assesses which blood level to determine the amount of circulating
medication in a patient?
a. Peak
b. Trough
c. Drug
d. Therapeutic
ANS: C
When a drug is circulating in the blood, a blood sample may be drawn and assayed to
determine the amount of drug present; this is known as the drug blood level. Peak levels
are only those drug blood levels that are at their maximum before metabolism starts to
decrease the amount of circulating drug. Trough levels are only those drug blood levels
that are at their minimum when metabolism has decreased the amount of circulating drug
and before an increase caused by a subsequent dose of the medication. Therapeutic
levels are only those within a prescribed range of blood levels determined to bring about
effective action of the medication.

8. The nurse administers 50 mg of a drug at 6:00 AM that has a half-life of 8 hours.

What time will it be when 25 mg of the drug has been eliminated from the body?
a. 8:00 AM
b. 11:00 AM
c. 2:00 PM
d. 6:00 PM
ANS: C
Fifty percent of the medication, or 25 mg, will be eliminated in 8 hours, or at 2:00 PM. 8:00
AM is 2 hours after administration; the half-life is 8 hours. 11:00 AM is 4 hours after
administration; the half-life is 8 hours. 6:00 PM is 12 hours after administration; the half-life
is 8 hours.
DIF: Cognitive Level: Analysis REF: Page 15 OBJ: 2
NOT: CONCEPT(S): Clinical Judgment; Safety; Elimination; Health Promotion
9. What will the nurse need to determine first in order to mix two drugs in the same
syringe?
a. Absorption rate of the drugs

b. Compatibility of the drugs
c. Drug blood level of each drug
d. Medication adverse effects
ANS: B
Knowledge of absorption is important but not in order to mix drugs. In order to mix two
drugs, compatibility is determined so there is no deterioration when the drugs are mixed in
the same syringe. Drug level does not indicate if it is acceptable to mix medications in the
same syringe. Adverse effects are important for the nurse to know, but not in order to mix
drugs.

10. A patient developed hives and itching after receiving a drug for the first time.
Which instruction by the nurse is accurate?
Stop the medication and encourage the patient to wear a medical alert bracelet that
a.
explains the allergy.
b. Explain to the patient that these are signs and symptoms of an anaphylactic reaction.
Emphasize to the patient the importance to inform medical personnel that in the future a
c.
lower dosage of this drug is necessary.
Instruct the patient that it would be safe to take the drug again because this instance
d.
was a mild reaction.
ANS: A
This initial allergic reaction is mild, and the patient is more likely to have an anaphylactic
reaction at the next exposure; a medical alert bracelet is necessary to explain the reaction.
Signs and symptoms of an anaphylactic reaction are respiratory distress and
cardiovascular collapse. A more severe reaction will occur at the next exposure, and the
patient should not receive the drug again.

11. When obtaining a patient’s health history, which assessment data would the
nurse identify as having the most effect on drug metabolism?
a. History of liver disease

b. Intake of a vegetarian diet
c. Sedentary lifestyle
d. Teacher as an occupation
ANS: A
Liver enzyme systems are the primary site for metabolism of drugs. Intake of a vegetarian
diet may affect absorption but not metabolism. Sedentary lifestyle and occupations could
affect metabolism (exposure to environmental pollutants), but these do not have the most
significant effect on metabolism.

12. A physician’s order indicates to administer a medication to the patient via the
percutaneous route. The nurse can anticipate that the patient will receive this
medication
a. intramuscularly.
b. subcutaneously.
c. topically.
d. rectally.
ANS: C
The percutaneous route refers to drugs that are absorbed through the skin and mucous
membranes. Methods of the percutaneous route include inhalation, sublingual (under the
tongue), or topical (on the skin) administration. The parenteral route bypasses the
gastrointestinal (GI) tract by using subcutaneous (subcut), intramuscular (IM), or
intravenous (IV) injection. The parenteral route bypasses the GI tract by using subcut, IM,
or IV injection. In the enteral route, the drug is administered directly into the GI tract by the
oral, rectal, or nasogastric route.

13. A nurse is preparing to administer tetracycline to a patient diagnosed with an

infection. Which medication should not be administered with tetracycline?
a. Ativan
b. Tylenol
c. Colace
d. Mylanta
ANS: D
Administering tetracycline with Mylanta can provide an antagonistic effect that will result in
decreased absorption of the tetracycline. Ativan, Tylenol, and Colace are not
contraindicated to administer with tetracycline.
DIF: Cognitive Level: Application REF: Page 18 OBJ: 5 | 6

MULTIPLE RESPONSE
1. Which statement(s) about liberation of drugs is/are true? (Select all that apply.)
a. A drug must be dissolved in body fluids before it can be absorbed into body tissues.
A solid drug taken orally must disintegrate and dissolve in GI fluids to allow for
b.
absorption into the bloodstream for transport to the site of action.
The process of converting the drug into a soluble form can be controlled to a certain
c.
degree by the dosage form.
Converting the drug to a soluble form can be influenced by administering the drug with
d.
or without food in the patient’s stomach.
e. Elixirs take longer to be liberated from the dosage form.
ANS: A, B, C, D
Regardless of the route of administration, a drug must be dissolved in body fluids before it
can be absorbed into body tissues. Before a solid drug taken orally can be absorbed into
the bloodstream for transport to the site of action, it must disintegrate and dissolve in the
GI fluids and be transported across the stomach or intestinal lining into the blood. The
process of converting a drug into a soluble form can be partially controlled by the
pharmaceutical dosage form used (e.g., solution, suspension, capsules, and tablets with
various coatings). The conversion process can also be influenced by administering the
drug with or without food in the patient’s stomach. Elixirs are already drugs dissolved in a
liquid and do not need to be liberated from the dosage form.

2. Which are routes of drug excretion? (Select all that apply.)
a. GI tract; feces
b. Genitourinary (GU) tract; urine
c. Lymphatic system
d. Circulatory system; blood/plasma
e. Respiratory system; exhalation
ANS: A, B, E
The GI system is a primary route for drug excretion. The GU and the respiratory systems
do function in the excretion of drugs. The lymphatic and circulatory systems are involved
with drug distribution, not drug excretion.

NOT: CONCEPT(S): Patient Education; Clinical Judgment; Safety; Elimination
3. Which route(s) enable(s) drug absorption more rapidly than the subcut route?
(Select all that apply.)
a. IV route
b. IM route
c. Inhalation/sublingual
d. Intradermal route
e. Enteral route
ANS: A, B, C
IV route of administration enables drug absorption more rapidly than the subcut route. IM
route of administration enables drug absorption more rapidly because of greater blood
flow per unit weight of muscle. Inhalation/sublingual route of administration enables drug
absorption more rapidly than the subcut route. Intradermally administered drugs are
absorbed more slowly because of the limited available blood supply in the dermis.
Enterally administered drugs are absorbed more slowly because of the biotransformation
process.
DIF: Cognitive Level: Comprehension REF: Page 14 OBJ: 1 | 3

4. The nurse recognizes that which factor(s) would contribute to digoxin toxicity in a
92-year-old patient? (Select all that apply.)
a. Taking the medication with meals

b. Prolonged half-life of the drug digoxin
c. Impaired renal function
d. Diminished mental capacity
ANS: B, C
Impaired renal and hepatic function in older adults impairs metabolism and excretion of
drugs, thus prolonging the half-life of a medication. Food would decrease the absorption of
the drug. Diminished mental capacity does not contribute to drug toxicity unless it is due to
administration errors.
DIF: Cognitive Level: Application REF: Page 15 OBJ: 2 | 3 | 7
MSC: NCLEX Client Needs Category: Health Promotion and Maintenance
5. Which statement(s) about variables that influence drug action is/are true? (Select all
that apply.)
An older adult will require increased dosage of a drug to achieve the same therapeutic
a.
effect as that seen in a younger person.
b. Body weight can affect the therapeutic response of a medication.
c. Chronic smokers may metabolize drugs more rapidly than nonsmokers.
d. A patient’s attitude and expectations affect the response to medication.
e. Reduced circulation causes drugs to absorb more rapidly.
ANS: B, C, D
Body weight can affect response to medications; typically, obese patients require an
increase in dosage and underweight patients a decrease in dosage. Chronic smoking
enhances metabolism of drugs. Attitudes and expectations play a major role in an
individual’s response to drugs. Older adults require decreased dosages of drugs to
achieve a therapeutic effect. Decreased circulation causes drugs to absorb more slowly.
DIF: Cognitive Level: Comprehension REF: Page 16 | Page 17

OBJ: 5 | 6 | 7 TOP: Nursing Process Step: Implementation
6. Which factor(s) affect(s) drug actions? (Select all that apply.)
a. Teratogenicity
b. Age
c. Body weight
d. Metabolic rate
e. Illness
ANS: B, C, D, E
Age, body weight, metabolic rate, and illness may contribute to a variable response to a
medication. Teratogenicity does not contribute to a variable response to a medication.

OBJ: 7 TOP: Nursing Process Step: Assessment
COMPLETION
1. A patient receives 200 mg of a medication that has a half-life of 12 hours. How

many mg of the drug would remain in the patient’s body after 24 hours?
ANS:
50
The half-life is defined as the amount of time required for 50% of the drug to be eliminated
from the body. If a patient is given 200 mg of a drug that has a half-life of 12 hours, then
50 mg of the drug would remain in the body after 24 hours.
DIF: Cognitive Level: Analysis REF: Page 15 OBJ: 2 | 3

Chapter 14: Drugs Used for Parkinson’s Disease

MULTIPLE CHOICE
1. Which adverse effects associated with levodopa therapy would support the nursing
diagnosis risk for injury?
a. Nausea and vomiting

b. Orthostatic hypotension
c. Anorexia and depression
d. Tachycardia and palpitations
ANS: B
When initiating levodopa therapy, orthostatic hypotension may occur. Although generally
mild, patients may experience dizziness and weakness. Symptoms usually resolve within
1 or 2 weeks once tolerance is developed to the levodopa therapy. Orthostatic
hypotension increases the risk for injury in Parkinson’s patients because they are also
experiencing alterations in gait patterns. Although nausea, vomiting, anorexia, and
depression are adverse effects of levodopa, they do not contribute to a risk for falling.
Tachycardia and palpitations are not common adverse effects of levodopa.

TOP: Nursing Process Step: Diagnosis
MSC: NCLEX Client Needs Category: Safe, Effective Care Environment
NOT: CONCEPT(S): Clinical Judgment; Patient Education; Safety
2. Which vitamin will reduce the therapeutic effects of levodopa?
a. A
b. B6
c. C
d. D
ANS: B
Pyridoxine (vitamin B6) will reduce the therapeutic effects of levodopa in oral doses of 5 to
10 mg or more. Generally, diets typically have less than 1 mg of vitamin B6 and therefore
are not restricted. The ingredients in multivitamins, however, must be assessed. Vitamins
A, C, and D do not affect therapy with levodopa.

NOT: CONCEPT(S): Clinical Judgment; Patient Education
3. Which cholinergic symptoms of Parkinson’s disease are reduced with anticholinergic

drugs?
a. Cognitive impairments
b. Rigidity
c. Tremors and drooling
d. Postural abnormalities
ANS: C
Anticholinergic drugs will reduce the severity of tremors and drooling in patients with
Parkinson’s disease. Anticholinergics are most useful when used in combination with
levodopa. Anticholinergic drugs do not affect cognitive impairments. Anticholinergics have
little effect on rigidity or on postural abnormalities.

4. What is the pharmacologic action of entacapone, a potent catechol O methyl

transferase (COMT) inhibitor?
a. Slows the deterioration of dopaminergic nerve cells
b. Inhibits the relative excess of dopaminergic activity
c. Reduces the destruction of dopamine in peripheral tissues
d. Enhances the cholinergic symptoms of Parkinson’s disease
ANS: C
Entacapone, a COMT inhibitor, reduces dopamine destruction in peripheral tissues. This
significantly increases the amount of dopamine available to reach the brain. Entacapone,
when used with carbidopa levodopa therapy, results in more constant dopaminergic
stimulation. Entacapone is not effective when used alone. Entacapone does not affect the
nerve cells but blocks enzymes that break down levodopa. Parkinson’s disease is
characterized by a relative deficit of dopaminergic activity. Entacapone does not affect
cholinergic symptoms of Parkinson’s disease.

5. The nurse is teaching a patient with Parkinson’s disease about levodopa. Which
statement by the nurse is accurate regarding drug administration?
a. “Take this medication in between meals.”

b. “Take this medication at bedtime to prevent dizziness.”
c. “Take this medication when your tremors get worse.”
d. “Take this medication with food or antacids to reduce GI upset.”
ANS: D
Levodopa causes nausea, vomiting, and anorexia. Therefore, administration should be in
divided doses with food or antacids to decrease gastrointestinal (GI) irritation. Levodopa
should be taken with food. Levodopa must be taken on a regular schedule as prescribed
to provide therapeutic results.
6. Dopamine agonists have been linked with which adverse effects in patients with
Parkinson’s disease?
a. Oculogyric crisis
b. Tardive dyskinesia
c. Sudden sleep events
d. Akathisia
ANS: C
Sleep episodes have been reported with the dopamine agonists bromocriptine, pergolide,
pramipexole, and ropinirole. These are described as “sleep attacks,” including daytime
sleep. Oculogyric crisis is an adverse effect of neuroleptic drugs such as phenothiazines.
Tardive dyskinesia is a dystonic adverse effect of neuroleptic drugs such as
phenothiazines. Akathisia, associated with neuroleptic drugs used in the treatment of
mental disorders, is characterized by motor restlessness accompanied by increased
nervous or restless movement. The syndrome may also occur when anti Parkinson drugs
are reduced or discontinued.

NOT: CONCEPT(S): Clinical Judgment; Patient Education; Safety
7. What is the rationale for administering levodopa instead of dopamine for treatment
of Parkinson’s disease?
a. Dopamine does not cross the blood–brain barrier when administered orally.
b. Levodopa is much less expensive.
c. The half-life of dopamine is too short.
d. Dopamine has too many reactions with other medications.
ANS: A
When administered orally, dopamine does not enter the brain. Levodopa does cross into
the brain and is metabolized into dopamine. Dopamine is not available as an oral
medication. The half-life of levodopa is approximately 50 minutes; the half-life of dopamine
is approximately 4 days. Dopamine does not react with medications.

NOT: CONCEPT(S): Clinical Judgment; Patient Education; Health Promotion
8. The nurse is providing education to a patient recently placed on selegiline

disintegrating tablets. Which statement by the patient indicates a need for further
teaching?
a. “This medication will help slow the development of symptoms.”

b. “I will place the tablet on my tongue before breakfast.”
c. “I may need to use a stool softener for constipation.”
d. “I should not push the tablet through the foil.”
ANS: B
Selegiline orally disintegrating tablets should be taken in the morning before breakfast,
without liquid. This medication is used to slow the development of symptoms and
progression of disease. Constipation is a common adverse effect that may require the use
of stool softeners. Patients should not attempt to push selegiline orally disintegrating
tablets through the foil backing. Patients should peel back the backing of one or two
blisters (as prescribed) with dry hands and gently remove the tablet(s).
9. The nurse is providing information to a patient recently prescribed entacapone.

Which statement is correct?
a. This medication is not to be taken with carbidopa levodopa.

b. Dosage is adjusted according to the patient’s response.
c. There will be fewer incidences of dopaminergic effects, such as confusion.
d. This medication increases the production of dopamine in the brain.
ANS: B
Dosage must be adjusted according to the patient’s response and tolerance. Entacapone
may be added to carbidopa levodopa therapy to prolong the activity of the dopamine by
slowing its rate of metabolism. Entacapone may increase the adverse dopaminergic
effects of levodopa. Entacapone does not increase the production of dopamine in the
brain.

10. The nurse is assessing an older patient with Parkinson’s disease who was
started on entacapone 1 week ago. The patient has a history of coronary artery
disease and takes an antihypertensive and aspirin. Which information would support
the need for a reduction in medication dosage by the health care provider?
a. Constipation
b. Brownish orange urine
c. Drowsiness
d. Dizziness
ANS: D
Dizziness is a symptom of orthostatic hypotension; dosages may need to be altered.
Constipation is an expected adverse effect of this medication. Brownish orange urine is an
expected adverse effect of this medication. Drowsiness is an expected adverse effect that
occurs when therapy is initiated.

NOT: CONCEPT(S): Clinical Judgment; Collaboration; Communication; Health
Promotion; Safety
11. When a patient taking a monoamine oxidase B inhibitor receives his dietary
tray, the nurse knows to remove the
a. cheese.
b. eggs.
c. bread.
d. coffee.
ANS: A
Patients taking monoamine oxidase B inhibitors should avoid food and beverages with a
high tyramine content, such as cheeses. Eggs, bread, and coffee do not have a high
tyramine content.

12. A patient taking rasagiline is assessed by the nurse to have a lasting
significant increase in blood pressure. When reviewing the patient’s current list of
medications, the nurse decides to hold the next dose of
a. dextromethorphan.
b. levodopa.
c. ciprofloxacin.
d. Valium.
ANS: C
Ciprofloxacin is an antibiotic that inhibits the metabolism of rasagiline, significantly raising
rasagiline serum levels and potentially causing significant hypertension.
Dextromethorphan, levodopa, and Valium are not related to significant hypertensive
changes when used in conjunction with rasagiline.

MSC: NCLEX Client Needs Category: Safe, Effective Care Environment| NCLEX Client
Needs Category: Physiological Integrity NOT: CONCEPT(S): Clinical
Judgment; Safety
MULTIPLE RESPONSE
1. Parkinson’s disease has which characteristic symptom(s)? (Select all that apply.)
a. Muscle tremors
b. Posture alterations
c. Muscle flaccidity
d. Tachycardia
e. Slow body movement
ANS: A, B, E
Symptoms of Parkinson’s disease include muscle tremors, posture and equilibrium
alterations, and slow body movement or bradykinesia. Muscle flaccidity is not a symptom
of Parkinson’s disease. Symptoms of Parkinson’s disease do not include alterations in
heart rate.

NOT: CONCEPT(S): Clinical Judgment
2. What point(s) should be included when teaching a patient about the use of
apomorphine for treatment of Parkinson’s disease? (Select all that apply.)
The restoration of function resulting from stimulation of dopamine receptors is

a.
permanent.
b. Apomorphine may be administered intravenously for rapid relief.
c. Apomorphine does not have any opioid activity.
d. A multidose injector pen is commonly used to administer apomorphine.
You may experience nausea and vomiting, which can be treated with
e.
trimethobenzamide (Tigan).
f. You may experience sleep attacks or episodes of daytime sleepiness.
ANS: C, D, E, F
Apomorphine has no opioid activity, is commonly injected by a reusable multidose pen,
and may cause nausea, vomiting, or sleepiness. Apomorphine brings temporary relief
from hypomobility. Apomorphine must not be administered intravenously. It may crystallize
in the vein and form a thrombus or embolism.
DIF: Cognitive Level: Comprehension REF: Page 210 OBJ: 4 | 6

3. The nurse is preparing to begin administration of apomorphine to a patient. Before
administering, the nurse will perform a baseline assessment of the patient’s (Select
all that apply.)
a. mobility.
b. orientation.
c. intellectual ability.
d. alertness.
e. vital signs.
ANS: A, B, D, E
Premedication assessment prior to apomorphine therapy should include baseline vital
signs, patient’s degree of mobility, alertness, and orientation to name, place, and time. It is
not necessary to assess intellectual ability prior to apomorphine therapy.

Chapter 28: Drugs Used for Diuresis

MULTIPLE CHOICE
1. What would the nurse anticipate if a patient with a history of type 2 diabetes is
prescribed a thiazide diuretic?
a. No change in the antidiabetic regimen

b. Decreased need for antidiabetic medication
c. Increased blood sugar levels
d. Less frequent monitoring of blood sugar level
ANS: C
The thiazides may induce hyperglycemia and aggravate cases of preexisting diabetes
mellitus. Regular assessment for glycosuria is indicated. Dosages of oral hypoglycemics
and insulin may need adjustment in patients with diabetes mellitus. Thiazides affect
glucose metabolism, and the patient should change her regimen to accommodate this.
Thiazides have the opposite effect on glucose metabolism. More frequent monitoring is
warranted when the patient is being treated with thiazide diuretics.

2. When teaching a patient who is taking thiazide diuretics, the nurse will encourage
the patient to increase the intake of which electrolyte?
a. Calcium
b. Sodium
c. Potassium
d. Magnesium
ANS: C
Thiazide diuretics cause a decrease in the level of potassium. The patient taking thiazide
diuretics does not need to increase calcium or magnesium intake. Although sodium levels
are altered in patients taking thiazide diuretics, patients do not need to increase sodium
intake.

NOT: CONCEPT(S): Clinical Judgment; Nutrition; Health Promotion
3. On admission, a patient with a history of cardiac insufficiency complains of

shortness of breath. The nurse auscultates the lungs and notes bilateral crackles
throughout both fields. In addition, there is bilateral +2 edema of the lower
extremities. Which medication does the nurse anticipate that the health care
provider will prescribe?
a. Allopurinol (Zyloprim)
b. Diphenhydramine (Benadryl)
c. Mannitol
d. Furosemide (Lasix)
ANS: D
Diuretics, such as furosemide, are the mainstays of treatment in heart failure and
hypertension. Allopurinol is used to treat gout. Diphenhydramine is an antihistamine and is
not used for diuresis. Mannitol is used mainly to treat cerebral edema.

NOT: CONCEPT(S): Clinical Judgment; Gas Exchange; Perfusion
4. Which medication is a potassium sparing diuretic?
a. Acetazolamide (Diamox)
b. Spironolactone (Aldactone)
c. Furosemide (Lasix)
d. Bumetanide (Bumex)
ANS: B
Spironolactone is a potassium sparing diuretic that blocks the sodium retaining and
potassium and magnesium excreting properties of aldosterone. This results in loss of
water, with increased sodium excretion and retention of potassium. Acetazolamide is a
carbonic anhydrase inhibitor and does not spare potassium. Furosemide is a loop diuretic.
Bumetanide is a loop diuretic and does not spare potassium.

NOT: CONCEPT(S): Clinical Judgment; Nutrition
5. How soon will diuresis be expected to occur after the nurse has administered 20 mg
of furosemide (Lasix) intravenously (IV) to a patient with heart failure?
a. As soon as injected
b. Within 10 minutes
c. After 2 hours
d. After 4 hours
ANS: B
The onset of diuresis following IV furosemide administration is 5 to 10 minutes after
administration. The diuretic effect peaks within 30 minutes and lasts approximately 2
hours.

NOT: CONCEPT(S): Clinical Judgment; Elimination
6. Which foods will the nurse recommend for a patient taking loop diuretics?
a. Protein-rich foods such as poultry, whole grains, and fish

b. Fiber-rich foods such as yellow vegetables, nuts, and lentils
c. Potassium-rich foods such as raisins, figs, and bananas
d. Sodium-rich foods such as canned vegetables and processed foods
ANS: C
Loop diuretics deplete potassium. Potassium-rich foods include raisins, figs, bananas,
peaches, kiwis, dates, apricots, oranges, prunes, melons, broccoli, and potatoes. Protein-
and fiber-rich foods are not needed in increased amounts by patients taking loop diuretics.
Because of high sodium content, canned foods are restricted for patients on diuretic
therapy.

NOT: CONCEPT(S): Clinical Judgment; Nutrition
7. Which condition warrants the use of acetazolamide (Diamox) as a diuretic?
a. Increased intracranial pressure

b. Increased extravascular fluid pressure
c. Increased intraocular pressure
d. Periorbital edema
ANS: C
Acetazolamide is used to reduce intraocular pressure associated with glaucoma. Mannitol
is an osmotic diuretic used to decrease intracranial pressure. Diuretics such as
furosemide or ethacrynic acid are used to reduce fluid volume in extravascular spaces.
Diuretics are not used to treat periorbital edema.

8. The nurse would expect to assess which serum potassium level in a patient who
has severe vomiting and diarrhea?
a. Less than 3.5 mEq/L

b. Between 3.5 and 4.5 mEq/L
c. Between 4.6 and 5 mEq/L
d. Higher than 5.5 mEq/L
ANS: A
Serum potassium (K+) levels would be less than 3.5 mEq/L. Hypokalemia is especially
likely to occur when a patient exhibits vomiting, diarrhea, or heavy diuresis. Between 3.5
and 4.5 mEq/L is the low end of normal range for serum potassium. Between 4.6 and 5
mEq/L is the high end of normal range for serum potassium. Serum K+ levels higher than
5.5 mEq/L indicate hyperkalemia, which occurs most commonly when a patient is given
excessive amounts of potassium supplementation.

NOT: CONCEPT(S): Clinical Judgment; Fluid and Electrolyte Balance
9. Which medication, if administered with spironolactone (Aldactone), will alert the

nurse to assess the patient for signs and symptoms of hyperkalemia?
a. Propranolol (Inderal)
b. Captopril (Capoten)
c. Furosemide (Lasix)
d. Ibuprofen (Motrin)
ANS: B
ACE inhibitors, such as captopril, inhibit aldosterone and thus may contribute to the
development of hyperkalemia. Beta blockers, such as propranolol, do not affect potassium
levels. Loop diuretics, such as furosemide, cause hypokalemia. NSAIDs, such as
ibuprofen, do not affect potassium levels.

10. The nurse has provided patient teaching about potassium sparing diuretic
therapy. Which statement by the patient indicates a need for further teaching?
a. “I will take my medication in the morning.”

b. “I will report a weight gain of 2 pounds in 2 days.”
c. “I will rise slowly when I get up from a sitting position.”
d. “I will use a salt substitute because I limit my salt intake.”
ANS: D
Salt substitutes are potentially dangerous because they are high in potassium.

NOT: CONCEPT(S): Clinical Judgment; Nutrition; Patient Education
11. Which patient assessment would alert the nurse to withhold a loop diuretic?
a. Crackles in the lung bases

b. +2 pitting peripheral edema
c. Serum potassium of 2.6 mEq/L
d. Weight gain of 2 pounds in 2 days
ANS: C
The level indicates hypokalemia and could worsen with the administration of a loop
diuretic; therefore, the dose should be withheld. Crackles, peripheral edema, and weight
gain do not warrant withholding the medication.
DIF: Cognitive Level: Application REF: Page 434 | Page 436 | Page 437
12. A 37-year-old male presents at the emergency department reporting severe

vomiting for the past 48 hours. When assessing skin turgor, the nurse will
a. exert pressure against the shin.

b. gently pinch the skin together over the sternum.
c. assess for vein distention.
d. inspect oral mucous membranes.
ANS: B
Skin turgor is assessed by gently pinching the skin together over the sternum, on the
forehead, or on the forearm. Elasticity is present and skin rapidly returns to a flat position
in the well-hydrated patient. Exerting pressure against the shin would assess for edema.
Vein distention and oral mucous membranes are indicators of hydration status but are not
considered when assessing skin turgor.

13. The nurse is reviewing lab work received on a patient admitted with the
diagnosis of dehydration. The nurse will notify the physician of which lab value?
a. Serum sodium level: 115 mEq/L

b. Serum potassium level: 5.0 mEq/L
c. Serum sodium level: 140 mEq/L
d. Serum potassium level: 3.5 mEq/L
ANS: A
A serum sodium level lower than 135 mEq/L is considered hyponatremia. A serum
potassium level of 3.5 or 5.0 mEq/L and a serum sodium level of 140 mEq/L are
considered within normal limits.

TOP: Nursing Process Step: Assessment | Nursing Process Step: Implementation
MULTIPLE RESPONSE
1. A patient who has heart failure and difficulty breathing is being admitted. Which
physical assessment(s) indicate(s) fluid volume excess? (Select all that apply.)
a. Rapid, bounding, irregular pulse rate

b. Clear lung sounds
c. 3+ pitting ankle edema
d. Neck vein engorgement
e. Shortness of breath
ANS: A, C, D, E
The patient with overhydration caused by heart failure often presents with a rapid and
irregular pulse rate, peripheral and abdominal edema, distended neck veins, dyspnea and
adventitious breath sounds of crackles and/or rhonchi in lung fields.
DIF: Cognitive Level: Application REF: Page 433 | Page 434

2. Which premedication assessment(s) would the nurse obtain prior to the initiation of
bumetanide (Bumex)? (Select all that apply.)
a. Serum potassium
b. Bowel sounds
c. Lung sounds
d. Orientation level
e. Blood pressure
ANS: A, C, D, E
Serum potassium levels may be altered because of bumetanide therapy and therefore
need to be assessed. Lung sounds, orientation level, and vital signs need to be assessed
prior to initiation of therapy. Bowel sounds are not generally assessed prior to bumetanide
therapy.
DIF: Cognitive Level: Application REF: Page 436 OBJ: 1 | 2 | 5

3. Which are common signs and symptoms of dehydration? (Select all that apply.)
a. Furrowed tongue
b. Decreased intake and output levels
c. Bounding pulse rate
d. Mental confusion
e. Elastic skin turgor
ANS: A, B, D
Furrowed tongue is a sign of dehydration. Signs of dehydration and hyponatremia include
decreased intake and output or output greater than intake. Signs of dehydration may also
include possible mental confusion, weak pulse/weak pedal pulses, inelastic skin turgor,
and delayed capillary refill.

4. Which nursing intervention(s) would be performed for a patient who is on diuretic

therapy? (Select all that apply.)
a. Auscultation of lung sounds

b. Assessment of skin turgor
c. Initiation of electrolyte supplements
d. Positioning techniques
e. Monitoring of intake and output
ANS: A, B, D, E
Lungs should be auscultated to detect the presence of fluid as a result of heart failure.
Skin turgor is directly related to the degree of hydration. Skin that is well hydrated is
elastic and rapidly returns to a flat position after being pinched. In dehydrated patients, the
skin remains in a peaked or pinched position and returns very slowly to the flat, normal
position. Positioning techniques are essential to avoid skin breakdown resulting from
edema or dehydration. Assessment of intake and output will assist in determining the
effectiveness of diuretic therapy. The health care provider, not the nurse, will determine
the need for electrolyte supplementation. When ordered, the nurse will administer the
appropriate replacements. Maintaining the ordered diet therapy is within the role of the
nurse.

OBJ: 1 | 5 TOP: Nursing Process Step: Implementation
5. Which sign(s) and/or symptom(s) of dehydration may occur as a result of a diuretic?

a. Decreased urine specific gravity

b. Skin remains peaked on turgor assessment
c. Bounding peripheral pulses
d. Neck vein engorgement
e. Soft, sunken eyeballs
ANS: B, E
A sign of dehydration is skin that is nonelastic or does not return to normal position when
pulled taut on assessment. A sign of dehydration is eyeballs that appear soft or sunken.
Dehydrated patients have a urine specific gravity and weak pulses. Overhydrated patients
have engorged neck veins.

OBJ: 1 | 5 TOP: Nursing Process Step: Assessment
6. Which medical condition(s) may contribute to fluid volume excess? (Select all that
apply.)
a. Hypertension
b. Liver disease
c. Pregnancy
d. Use of corticosteroids
e. Skin disorders
ANS: A, B, C, D
Hypertension, underlying medical diseases of the liver, pregnancy, and use of
corticosteroids may contribute to fluid volume excess. Skin disorders do not contribute to
fluid volume excess.

7. Individuals with which disorder(s) are particularly susceptible to the development of

electrolyte disturbances during diuretic therapy? (Select all that apply.)
a. History of cardiac disease

b. History of renal disease
c. History of hormonal disorders
d. History of psychiatric illness
e. Massive trauma
f. Serious burns
g. Overhydration
ANS: A, B, C, E, F
Patients with cardiac disease, renal disease, hormonal disorders, massive trauma, and
serious burns are at risk for developing electrolyte imbalance during diuresis therapy.
Psychiatric disorders do not have an effect on diuretic treatment. Although overhydration
may cause an electrolyte disturbance, it is not related to diuretic treatment.

8. The nurse transcribes a new order for ethacrynic acid (Edecrin) on a patient with
edema resulting from cirrhosis of the liver. Which currently prescribed medication(s)
should the nurse report to the ordering health care provider? (Select all that apply.)
a. Digoxin
b. Prednisone
c. Tobramycin
d. Lipitor
e. Zofran
ANS: A, B, C
Drug interactions with ethacrynic acid (Edecrin) include digoxin, corticosteroids (such as
prednisone), and aminoglycosides (such as tobramycin). Lipitor (a statin drug) and Zofran
(an antiemetic) are not of concern when administered with ethacrynic acid.

TOP: Nursing Process Step: Assessment | Nursing Process Step: Implementation
MSC: NCLEX Client Needs Category: Safe, Effective Care Environment| NCLEX Client
Needs Category: Physiological Integrity
NOT: CONCEPT(S): Clinical Judgment; Collaboration; Communication; Care
Coordination
Chapter 48: Substance Abuse

MULTIPLE CHOICE
1. A 16-year-old male has been referred to the community mental health center
following legal charges of driving under the influence. Which screening tests would
be appropriate to use on this patient?
a. Drug Abuse Screening Test (DAST)

b. Adolescent Alcohol Involvement Scale (AAIS)
c. Adolescent Drug Abuse Diagnosis (ADAD)
d. Minnesota Multiphasic Personality Inventory (MMPI 2)
ANS: B
The adolescent patient has legal problems associated with alcohol use. The AAIS
screening instrument would be appropriate to use. DAST is a comprehensive screening
and assessment instrument. ADAD is an adolescent drug abuse diagnosis instrument.
MMPI is a personality inventory.

MSC: NCLEX Client Needs Category: Psychosocial Integrity
NOT: CONCEPT(S): Clinical Judgment; Addiction
2. A patient admitted 48 hours ago has a diagnosis of gastrointestinal (GI) bleeding

and is receiving IV hydration and transfusions. When making rounds, the nurse
observes the patient to be having a tonic-clonic seizure. What may be the cause of
the seizure?
a. Low blood counts as a result of bleeding

b. Alcohol withdrawal
c. Alkalosis
d. Inadequate nutrition
ANS: B
Alcohol withdrawal symptoms can begin within a few hours of discontinuation of drinking
and may continue for 3 to 10 days. Withdrawal symptoms may be severe and include
visual and auditory hallucinations and tonic-clonic seizures. The patient’s admitting
diagnosis, GI bleeding, may be associated with alcohol abuse. Denial is a common
symptom associated with alcoholism, and the patient may not have been honest about
alcohol intake when the health care provider took the history on admission. History may
be obtained from the patient’s family or significant other. It is unlikely that the blood loss is
significant enough to induce seizures. Alkalosis is not likely the cause of seizures in this
case; the patient is more likely to be acidotic from the combined dehydration and
withdrawal. Common causes in the setting of alcohol withdrawal include alcoholic
ketoacidosis and ingestion of alcohols or medications that result in metabolic acidosis
(e.g., methanol, ethylene glycol, salicylate). Inadequate nutrition is not likely to cause
seizures in this patient.

3. A nurse working the night shift suspects that a colleague is abusing alcohol. Which
action by the nurse is most important?
a. “Good faith” reporting is unfaithful to a colleague.

b. Reporting will result in loss of the colleague’s license.
c. It is not of concern, and the nurse won’t be penalized for refusing to get involved.
d. State guidelines may mandate to report substance abuse.
ANS: D
In some states, when substance abuse of a colleague is suspected, reporting is
mandatory. Professionals must be loyal to their patients and protect them from harm.
“Good faith” reporting should not be viewed as disloyalty to a colleague. Licenses are
often not revoked when a colleague self-reports or is reported for substance abuse. Health
professionals may be named in a civil lawsuit if they fail to report suspected impairment of
another professional.
NOT: CONCEPT(S): Clinical Judgment; Addiction; Health Care Law
4. What does a urinalysis that is positive for the drug tested indicate?
a. It indicates illegal drug use.

b. It verifies drug dependency.
c. It is a violation of the individual’s constitutional rights.
d. It verifies whether the drug is present in the specimen.
ANS: D
Positive urinalysis simply indicates the presence of the drug being tested for in the urine
specimen. The person may have a prescription for a substance found in the urine or may
have been accidentally dosed with it. Presence of the substance in the urine does not
indicate dependence because the person may only be an episodic user of the substance.
Asking for the person’s permission to collect a specimen and examine it does not violate
the person’s constitutional rights. The Supreme Court has ruled that drug screening does
not violate one’s constitutional right to privacy or represent an unreasonable search.
DIF: Cognitive Level: Comprehension REF: Page 779 OBJ: N/A

5. What will the nurse instruct patients who are on daily disulfiram (Antabuse) to
avoid?
a. All forms of cough syrup

b. Alcohol
c. Benzodiazepines
d. Aspirin products
ANS: B
Disulfiram is used to reduce the desire for alcohol by inducing severe nausea and
vomiting when a patient ingests alcohol while on this drug. Reactions can be quite severe,
and patients must understand the need to avoid all forms of alcohol while taking this
medication. Not all cough syrups contain alcohol. Benzodiazepines and aspirin do not
react with disulfiram.

NOT: CONCEPT(S): Clinical Judgment; Addiction; Safety; Patient Education
6. Which protects individuals who have been successfully rehabilitated from substance
abuse from discrimination related to past addiction?
a. Americans with Disabilities Act (ADA)

b. National Council on Alcoholism and Drug Dependence
c. Bureau of Alcohol, Tobacco, Firearms and Explosives (ATF)
d. American Medical Association (AMA)
ANS: A
Persons dependent on drugs, but who are no longer using drugs illegally and are
receiving treatment for chemical dependence, or who have been rehabilitated successfully
are protected by the ADA from discrimination on the basis of past drug addiction. The
National Council on Alcoholism and Drug Dependence is a voluntary health agency
dedicated to educating the public about alcoholism. The ATF is a principal law
enforcement agency in the U.S. Department of Justice dedicated to preventing terrorism,
reducing violent crime, and protecting the United States. The AMA is a professional
organization for physicians.
NOT: CONCEPT(S): Clinical Judgment; Addiction; Health Care Law
7. What must be administered before glucose infusions for a patient in alcohol

withdrawal to prevent Wernicke’s encephalopathy?
a. Chlordiazepoxide (Librium)
b. Thiamine
c. Diazepam (Valium)
d. Bromocriptine (Parlodel)
ANS: B
Thiamine and multiple vitamins should be administered routinely to patients in alcohol
withdrawal. Intravenous fluid therapy for rehydration may be necessary, but thiamine must
be administered before glucose infusion to prevent Wernicke’s encephalopathy.
Benzodiazepines are given for treatment of anxiety and seizures associated with alcohol
withdrawal. Bromocriptine is not used to prevent Wernicke’s encephalopathy.

NOT: CONCEPT(S): Clinical Judgment; Addiction; Safety
8. What effect will occur if a patient being treated with naltrexone (ReVia) for
substance abuse ingests opioids or alcohol?
a. Increased euphoria
b. Nausea, vomiting, and diarrhea
c. Deep sedation
d. An absence of the “high” associated with drugs
ANS: D
Naltrexone is an opioid antagonist prescribed to block the pharmacologic effects of the
“high” associated with opioids and alcohol. Studies report less alcohol craving and fewer
drinking days, especially when naltrexone is combined with psychosocial treatment.
Naltrexone prevents the euphoria associated with taking drugs like opioids and alcohol.
These are symptoms of taking alcohol in combination with disulfiram (Antabuse).
Naltrexone is not sedating.

OBJ: 5 TOP: Nursing Process Step: Evaluation
9. A patient is admitted into a substance abuse treatment center and is withdrawing

from alcohol. Which statement made by the patient’s family member shows a need
for further education?
a. “Withdrawal symptoms can begin within a few hours of discontinuation of drinking.”

b. “Withdrawal symptoms will improve within 24 hours.”
c. “Less than 1% of patients develop delirium tremens.”
d. “Benzodiazepines are commonly used for detoxification.”
ANS: B
Withdrawal symptoms may continue for 3 to 10 days. Withdrawal symptoms can begin
within a few hours of discontinuation of drinking. Less than 1% of patients develop
delirium tremens. Benzodiazepines are commonly used for detoxification.

NOT: CONCEPT(S): Clinical Judgment; Addiction; Safety; Communication
10. The nurse is assisting with the development of care plan for a patient
withdrawing from cocaine. What would be the first nursing diagnosis priority for this
patient?
a. Altered nutrition; less than body requirements

b. Risk for altered peripheral tissue perfusion
c. Risk for fluid volume deficit
d. High risk for self-directed violence
ANS: D
Depression with suicidal ideation is generally the most serious problem associated with
cocaine withdrawal. Altered nutrition, risk for altered peripheral tissue perfusion, and risk
for fluid volume deficit are not the priorities for a patient withdrawing from cocaine.

TOP: Nursing Process Step: Diagnosis
NOT: CONCEPT(S): Clinical Judgment; Addiction; Safety; Interpersonal Violence
11. The nurse is transcribing an order for disulfiram on a patient in alcohol

rehabilitation. When planning the time of day to administer this medication the nurse
will document that disulfiram be given
a. before breakfast.
b. with lunch.
c. before dinner.
d. at bedtime.
ANS: D
Disulfiram should be administered at bedtime to avoid the complications of sedative
effects.
12. Which patient assessment will the nurse expect to observe when a patient has
ingested alcohol while on disulfiram (Antabuse)?
a. Unconsciousness
b. Hypertension
c. GI bleeding
d. Severe vomiting
ANS: D
Severe vomiting occurs when alcohol is ingested while a patient is on disulfiram therapy.
Disulfiram blocks the metabolism of acetaldehyde, a metabolite of alcohol. Elevated levels
of acetaldehyde produce a reaction causing nausea, severe vomiting, sweating, throbbing
headache, dizziness, blurred vision, and confusion. Disulfiram will not generally cause
unconsciousness when alcohol is ingested with it, does not cause hypertension when
taken in combination with alcohol, and does not cause GI bleeding.

13. What is the rationale for administering acamprosate (Campral)?
a. Withdrawal from alcohol addiction

b. Maintenance of sobriety
c. Improvement of renal function
d. Correction of electrolyte imbalances
ANS: B
Acamprosate is used in alcohol rehabilitation programs for chronic alcoholics who want to
maintain sobriety. Drugs likely to be given during withdrawal from alcohol addiction include
anticonvulsants, thiamine, benzodiazepines, and beta blockers. Acamprosate does not
improve renal function. Acamprosate does not correct electrolyte imbalances.

MULTIPLE RESPONSE
1. What important point(s) of patient education should be included about disulfiram

(Antabuse) therapy? (Select all that apply.)
The patient should return for liver function tests in 10 to 14 days following initiation of
a.
therapy.
Headache, fatigue, and a metallic taste are common adverse effects that usually
b.
resolve.
c. Avoid alcohol ingestion to prevent a reaction.
Carefully read all labels for possible alcohol content, including perfumes and over-the-
d.
counter (OTC) medications such as cough syrups.
e. Report to the health care provider any allergic symptoms, such as hives or pruritus.
ANS: A, B, C, D
Baseline laboratory data include liver function tests and alcohol screening. Headache,
fatigue, and a metallic taste are common adverse effects of disulfiram. Disulfiram is a drug
used to treat chronic alcoholism that produces a very unpleasant reaction to alcohol.
Patients should be instructed to read all labels of topical substances and OTC drugs for
alcohol content, as well as avoiding any foods that may be prepared with alcohol.
Disulfiram is unlikely to cause allergic reactions.

NOT: CONCEPT(S): Clinical Judgment; Addiction; Safety Patient Education
2. A health professional colleague is suspected of having a substance abuse problem

because of the person’s frequent absenteeism, mood swings when at work,
diminished alertness, and poor patient care. Which action(s) will the nurse take?
a. Confront the individual.

b. Document specific examples of inappropriate actions.
Avoid assigning this individual to patients with narcotic medication orders or high
c.
acuities.
d. Notify law enforcement of the suspicions.
e. Submit a confidential report to an appropriate supervisor.
ANS: B, E
Observation and documentation are crucial to building a record of repeat instances over
time to support the suspicion of impairment. Examples of inappropriate actions need to be
well documented over time. An accurate record can also be useful in helping the impaired
individual to recognize the problems and submit voluntarily to treatment. If a health
professional suspects that a colleague is impaired, a confidential report should be made to
an appropriate supervisor familiar with institutional policy. Confronting the individual,
avoiding assigning this individual to patients with narcotic medication orders or high
acuities, and notifying law enforcement of the suspicions are not appropriate actions to
take.

OBJ: 3 TOP: Nursing Process Step: Implementation
3. A patient has completed substance abuse treatment for alcoholism. What will assist
in long-term goal attainment and promote abstinence? (Select all that apply.)
a. Naltrexone therapy
b. Regular attendance at NA
c. Regular contact with his program sponsor
d. Following the 12-step program of AA
e. Diazepam therapy to reduce the likelihood of DTs
ANS: A, C, D
Treatment may require pharmacologic treatment, such as disulfiram or naltrexone therapy.
Regular contact with a sponsor provides support and continuity in the process of
maintaining sobriety. Treatment requires lifelong effort with a combination of psychosocial
support; use of the 12-step program will assist the patient in maintaining recovery. NA
stands for Narcotics Anonymous; this patient should attend meetings of AA, or Alcoholics
Anonymous. Diazepam has a high potential for abuse and should not be used with
recovering addicts.
DIF: Cognitive Level: Application REF: Pages 781-782

OBJ: 4 TOP: Nursing Process Step: Implementation
NOT: CONCEPT(S): Clinical Judgment; Addiction; Health Promotion
4. Clonidine (Catapres) is used in treating which opioid withdrawal symptom(s)?

a. Hypertension
b. Tremors
c. Agitation
d. Depression
e. Sweating
f. Nausea
ANS: B, C, E
Clonidine is useful in decreasing tremors, agitation, and sweating associated with opioid
withdrawal. Clonidine does not have a hypotensive effect, treat depression, or alleviate
nausea.


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Chapter 02: Basic Principles of Drug Action and Drug Interactions

Clayton/Willihnganz: Basic Pharmacology for Nurses, 17th Edition

a. Notify physician of allergic reaction.

DIF: Cognitive Level: Application REF: Page 17 OBJ: 4

DIF: Cognitive Level: Knowledge REF: Page 18 OBJ: 4

3. Which is the best description of when drug interactions occur?

a. On administration of toxic dosages of a drug

DIF: Cognitive Level: Comprehension REF: Page 18 OBJ: 5

DIF: Cognitive Level: Comprehension REF: Page 19 OBJ: 6

5. What do drug blood levels indicate?

a. They confirm if the patient is taking a generic form of a drug.

DIF: Cognitive Level: Comprehension REF: Page 17 OBJ: 4

6. What is the process by which a drug is transported by circulating body fluids to

DIF: Cognitive Level: Comprehension REF: Page 15 OBJ: 3

DIF: Cognitive Level: Comprehension REF: Page 17 OBJ: 3

8. The nurse administers 50 mg of a drug at 6:00 AM that has a half-life of 8 hours.

a. Absorption rate of the drugs

DIF: Cognitive Level: Application REF: Page 19 OBJ: 6

DIF: Cognitive Level: Application REF: Page 18 OBJ: 4

a. History of liver disease

DIF: Cognitive Level: Application REF: Page 16 OBJ: 3

DIF: Cognitive Level: Application REF: Page 14 OBJ: 1

13. A nurse is preparing to administer tetracycline to a patient diagnosed with an

DIF: Cognitive Level: Application REF: Page 18 OBJ: 5 | 6

DIF: Cognitive Level: Comprehension REF: Page 14 OBJ: 3

2. Which are routes of drug excretion? (Select all that apply.)

DIF: Cognitive Level: Knowledge REF: Page 15 OBJ: 3

DIF: Cognitive Level: Comprehension REF: Page 14 OBJ: 1 | 3

a. Taking the medication with meals

DIF: Cognitive Level: Comprehension REF: Page 16 | Page 17

6. Which factor(s) affect(s) drug actions? (Select all that apply.)

DIF: Cognitive Level: Comprehension REF: Page 16 | Page 17

1. A patient receives 200 mg of a medication that has a half-life of 12 hours. How

DIF: Cognitive Level: Analysis REF: Page 15 OBJ: 2 | 3

Chapter 14: Drugs Used for Parkinson’s Disease

a. Nausea and vomiting

DIF: Cognitive Level: Application REF: Page 208 OBJ: 6

2. Which vitamin will reduce the therapeutic effects of levodopa?

DIF: Cognitive Level: Comprehension REF: Page 208 OBJ: 6

3. Which cholinergic symptoms of Parkinson’s disease are reduced with anticholinergic

DIF: Cognitive Level: Knowledge REF: Page 215 OBJ: 7

4. What is the pharmacologic action of entacapone, a potent catechol O methyl

DIF: Cognitive Level: Knowledge REF: Page 202 OBJ: 5

a. “Take this medication in between meals.”

DIF: Cognitive Level: Comprehension REF: Page 213 OBJ: 6

DIF: Cognitive Level: Comprehension REF: Page 207 OBJ: 4

8. The nurse is providing education to a patient recently placed on selegiline

a. “This medication will help slow the development of symptoms.”

9. The nurse is providing information to a patient recently prescribed entacapone.

a. This medication is not to be taken with carbidopa levodopa.

DIF: Cognitive Level: Comprehension REF: Page 214 OBJ: 5

DIF: Cognitive Level: Application REF: Page 215 OBJ: 5

DIF: Cognitive Level: Application REF: Page 207 OBJ: 5

DIF: Cognitive Level: Analysis REF: Page 207 OBJ: 5

DIF: Cognitive Level: Knowledge REF: Page 200 OBJ: 1

The restoration of function resulting from stimulation of dopamine receptors is

DIF: Cognitive Level: Comprehension REF: Page 210 OBJ: 4 | 6

DIF: Cognitive Level: Application REF: Page 210 OBJ: 4 | 6

Chapter 28: Drugs Used for Diuresis