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Focus on Nursing Pharmacology | 9th Edition
by Rebecca Tucker | Test Bank with Verified
Questions and Answers
[1] Question: A nurse is preparing to administer an oral
medication that is known to have a high first-pass effect. The
nurse understands that this drug will be:
A) Rapidly absorbed in the stomach
B) Excreted unchanged by the kidneys
C) Extensively metabolized by the liver before reaching systemic
circulation
D) Bound to plasma proteins for an extended duration
Answer: C) Extensively metabolized by the liver before
reaching systemic circulation
Rationale: The first-pass effect refers to the metabolism of an
orally administered drug by the liver, reducing the amount of
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active drug that reaches systemic circulation. Drugs with a high
first-pass effect often require higher oral doses or alternative
routes (e.g., sublingual, IV) to achieve therapeutic effects.
[2] Question: A patient is receiving an intravenous infusion of a
drug that has a half-life of 6 hours. How long will it take for the
drug to reach steady state?
A) 6 hours
B) 12 hours
C) 24 hours
D) 30 hours
Answer: D) 30 hours
Rationale: Steady state is achieved after approximately 4–5
half-lives, assuming regular dosing intervals. For a drug with a 6-
hour half-life, steady state would be reached in about 24–30
hours (4–5 × 6 hours). This is the point where drug administration
and elimination are balanced.
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[3] Question: The nurse administers naloxone (Narcan) to a
patient who overdosed on morphine. The nurse understands that
naloxone works by:
A) Increasing the metabolism of morphine
B) Blocking opioid receptors without activating them
C) Enhancing the excretion of morphine
D) Decreasing the absorption of morphine
Answer: B) Blocking opioid receptors without activating them
Rationale: Naloxone is a competitive opioid antagonist. It binds
to mu-opioid receptors with high affinity but does not activate
them, thereby reversing the effects of opioid agonists such as
morphine, including respiratory depression. This action is an
example of pharmacodynamic antagonism.
[4] Question: A patient is prescribed warfarin (Coumadin) and is
also taking an over-the-counter herbal supplement. Which herbal
supplement would cause the greatest concern for increased
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bleeding risk?
A) St. John's wort
B) Saw palmetto
C) Garlic
D) Echinacea
Answer: C) Garlic
Rationale: Garlic has antiplatelet properties and can increase
the risk of bleeding when taken with anticoagulants such as
warfarin. St. John’s wort can decrease warfarin effectiveness by
inducing metabolism. Saw palmetto and echinacea have minimal
interaction with warfarin.
[5] Question: The nurse is educating a patient about a newly
prescribed medication that has a narrow therapeutic index. The
patient asks what this means. The best response is:
A) "The drug is unsafe to take with food."
B) "The drug has a small range between an effective dose and a
Focus on Nursing Pharmacology | 9th Edition
by Rebecca Tucker | Test Bank with Verified
Questions and Answers
[1] Question: A nurse is preparing to administer an oral
medication that is known to have a high first-pass effect. The
nurse understands that this drug will be:
A) Rapidly absorbed in the stomach
B) Excreted unchanged by the kidneys
C) Extensively metabolized by the liver before reaching systemic
circulation
D) Bound to plasma proteins for an extended duration
Answer: C) Extensively metabolized by the liver before
reaching systemic circulation
Rationale: The first-pass effect refers to the metabolism of an
orally administered drug by the liver, reducing the amount of
,Page 2 of 93
active drug that reaches systemic circulation. Drugs with a high
first-pass effect often require higher oral doses or alternative
routes (e.g., sublingual, IV) to achieve therapeutic effects.
[2] Question: A patient is receiving an intravenous infusion of a
drug that has a half-life of 6 hours. How long will it take for the
drug to reach steady state?
A) 6 hours
B) 12 hours
C) 24 hours
D) 30 hours
Answer: D) 30 hours
Rationale: Steady state is achieved after approximately 4–5
half-lives, assuming regular dosing intervals. For a drug with a 6-
hour half-life, steady state would be reached in about 24–30
hours (4–5 × 6 hours). This is the point where drug administration
and elimination are balanced.
,Page 3 of 93
[3] Question: The nurse administers naloxone (Narcan) to a
patient who overdosed on morphine. The nurse understands that
naloxone works by:
A) Increasing the metabolism of morphine
B) Blocking opioid receptors without activating them
C) Enhancing the excretion of morphine
D) Decreasing the absorption of morphine
Answer: B) Blocking opioid receptors without activating them
Rationale: Naloxone is a competitive opioid antagonist. It binds
to mu-opioid receptors with high affinity but does not activate
them, thereby reversing the effects of opioid agonists such as
morphine, including respiratory depression. This action is an
example of pharmacodynamic antagonism.
[4] Question: A patient is prescribed warfarin (Coumadin) and is
also taking an over-the-counter herbal supplement. Which herbal
supplement would cause the greatest concern for increased
, Page 4 of 93
bleeding risk?
A) St. John's wort
B) Saw palmetto
C) Garlic
D) Echinacea
Answer: C) Garlic
Rationale: Garlic has antiplatelet properties and can increase
the risk of bleeding when taken with anticoagulants such as
warfarin. St. John’s wort can decrease warfarin effectiveness by
inducing metabolism. Saw palmetto and echinacea have minimal
interaction with warfarin.
[5] Question: The nurse is educating a patient about a newly
prescribed medication that has a narrow therapeutic index. The
patient asks what this means. The best response is:
A) "The drug is unsafe to take with food."
B) "The drug has a small range between an effective dose and a
