Pharmacokinetics
A client asks the nurse why the oral pain medication they took this morning is taking longer to work than the IV pain medication they received last night. Which explanation should the nurse give?
A. Oral medications are excreted by the kidneys before they can work.
B. IV medications have no absorption barrier and reach the bloodstream immediately.
C. IV medications are more fat-soluble than oral medications.
D. Oral medications are only distributed to the GI tract.
B. IV medications have no absorption barrier and reach the bloodstream immediately.
IV has no barrier to absorption and has immediate effects. Oral absorption is highly variable (GI pH, gastric emptying, food, first-pass effect).
A nurse is instilling otic (ear) drops for a 45-year-old client. How should the nurse straighten the ear canal?
A. Pull the pinna down and back
B. Pull the pinna up and back
C. Pull the earlobe straight down
D. Do not touch the ear; tilt the head forward
B. Pull the pinna up and back
Adults: up and back. Children 3 and under: down and back. Have the client stay side-lying for 2–3 minutes afterward.
A nurse is preparing to give morning medications to a client. Which action correctly verifies the right client?
A. Ask, "Are you Mr. Thompson?"
B. Check the room and bed number on the assignment sheet.
C. Compare the client's name and date of birth on the ID band with the MAR.
D. Ask the client's roommate to confirm the client's name.
C. Compare the client's name and date of birth on the ID band with the MAR.
Use two identifiers (name, ID number, birth date), check the ID band and allergies, and scan the barcode. A room number is never an identifier.
A client recently started on an antihypertensive reports feeling dizzy when getting out of bed. Which instruction should the nurse reinforce?
A. "Rise slowly, and sit or lie down if you feel dizzy."
B. "Take the medication on an empty stomach."
C. "Stop the medication until the dizziness goes away."
D. "Drink a large glass of grapefruit juice each morning."
A. "Rise slowly, and sit or lie down if you feel dizzy."
Antihypertensives can cause orthostatic hypotension. Teach the client to rise slowly and to sit or lie down if dizzy.
A client discharged after surgery with a prescription for oxycodone asks why the pharmacy won't let them refill it. Which explanation is correct?
A. "Oxycodone is Schedule II, so it needs a new written prescription and can't be refilled."
B. "Oxycodone is Schedule V, so it is sold over the counter instead."
C. "Oxycodone is Schedule I, so it can only be used in research."
D. "Oxycodone is Schedule IV, so it can only be refilled by phone."
A. "Oxycodone is Schedule II, so it needs a new written prescription and can't be refilled."
Schedule II (morphine, oxycodone, hydrocodone, Ritalin): high abuse potential, written prescription required, no refills.
A client asks if the store-brand ibuprofen is the same as Advil. Which response is correct?
A. "No, generics contain a different active ingredient."
B. "Yes, generics have the same active ingredient but may have different fillers."
C. "Yes, they are identical in every way, including the dyes and fillers."
D. "No, generics are not regulated by the FDA."
B. "Yes, generics have the same active ingredient but may have different fillers."
Generic = official name (ibuprofen) with the same active ingredient but different inactive fillers. Trade/brand names (Advil, Motrin) are capitalized and carry ® or ™.
A client receiving IV vancomycin has a prescription for a trough level. Which action should the nurse take?
A. Administer the dose and draw blood 30 minutes later.
B. Collect a urine specimen after the next dose.
C. Obtain a blood specimen immediately before the next scheduled dose.
D. Verify the client has received the drug for 24 hours, then draw blood at any time.
C. Obtain a blood specimen immediately before the next scheduled dose.
Trough = the lowest plasma level, so it is drawn right before the next dose. Peak is the highest level
A nurse is reinforcing teaching with a client who has a new transdermal patch. Which statement by the client indicates understanding?
A. "I will clean the site with an alcohol swab before applying the patch."
B. "I will put the new patch in the same spot as the old one."
C. "I will apply the patch to a clean, dry area of skin with no hair."
D. "I will rotate my application sites once a week."
C. "I will apply the patch to a clean, dry area of skin with no hair."
Apply to clean, dry, hairless skin. Rotate sites daily and never reuse the old site.
A client states, "I don't want to take that blood pressure pill. I don't want one more pill." Which response should the nurse make?
A. "Your provider prescribed it, so you really should take it."
B. "Tell me your concerns about taking this medication."
C. "Okay, I'll just give you your other medications."
D. "Let's just get it over with quickly."
B. "Tell me your concerns about taking this medication."
Right to refuse: explore the client's concerns, explain, inform the provider, and document. Don't coerce, and don't just skip it without follow-up.
A client taking warfarin asks about eating green leafy vegetables. Which response is correct?
A. "Avoid all foods containing vitamin K."
B. "Eat as many leafy greens as you can to prevent bleeding."
C. "Keep the amount of vitamin K–rich foods in your diet consistent."
D. "Only eat leafy greens within 2 hours of your dose."
C. "Keep the amount of vitamin K–rich foods in your diet consistent."
Vitamin K decreases warfarin's effect (higher clot risk). The goal is a consistent intake, not elimination.
A nurse notices a coworker with slurred speech, frequent medication errors, and repeated opioid count discrepancies. What should the nurse do?
A. Confront the coworker privately and keep it between them
B. Cover the coworker's patients so no one notices
C. Report the behavior to the supervisor
D. Wait until a client is harmed before reporting
C. Report the behavior to the supervisor
Report impaired coworkers to the supervisor; never cover it up. The supervisor reports to the Board of Nursing. Failing to report can make you responsible.
A client is prescribed levothyroxine after a thyroidectomy. The nurse knows that this medication is classified as which type?
A. Curative
B. Prophylactic
C. Replacement
D. Palliative
C. Replacement
Replacement drugs replace a missing substance (thyroid hormone). Prophylactic = vaccines and pre-op antibiotics; palliative = comfort (morphine for cancer pain); diagnostic = barium/contrast; destructive = antineoplastics.
An 84-year-old client with decreased liver function has a new prescription for a medication metabolized by the liver. What should the nurse anticipate?
A. A lower dose because the drug may accumulate in the body
B. A higher dose because older adults absorb less medication
C. Giving the medication with grapefruit juice to speed metabolism
D. Changing to the IM route so the liver is not involved
A. A lower dose because the drug may accumulate in the body
Older adults metabolize less, and liver failure slows metabolism, so a decreased dose is needed to prevent accumulation and toxicity.
A nurse is giving three medications to a client through a nasogastric (NG) tube. Which action is correct?
A. Flush the tube with water before and after each medication.
B. Crush all three, including the extended-release tablet, and mix them together.
C. Add the medications to the enteral feeding bag.
D. Give the sublingual medication through the tube with the others.
A. Flush the tube with water before and after each medication.
Give each medication separately, flush before and after each to prevent clogging, and flush with 30 mL at the end. Never crush TR/ER/EC drugs, never mix meds with feedings, and never give SL meds via tube.
A client has an IV antibiotic (time-critical medication) scheduled for 0900. Which administration time is within the acceptable window?
A. 0815
B. 0925
C. 1000
D. 1045
B. 0925
Time-critical meds: within 30 min (0830–0930). Non-time-critical meds given more than once daily: within 1 hr. Daily/weekly/monthly meds: within 2 hr.
A client taking an MAOI antidepressant is choosing lunch. Which choice indicates a need for further teaching?
A. Grilled chicken with white rice
B. Baked fish with steamed broccoli
C. Plain pasta with steamed vegetables
D. Aged cheddar and salami on a cracker plate
D. Aged cheddar and salami on a cracker plate
MAOIs + tyramine (aged cheese, processed meats, wine, overripe fruit, organ meats) can cause a hypertensive crisis.
A client taking a newly approved medication develops a serious adverse reaction not listed in the drug information. Where should this be reported?
A. The DEA
B. The FDA's MedWatch program
C. OSHA
D. The United States Pharmacopeia
B. The FDA's MedWatch program
Unreported adverse effects can still appear with new medications (Phase IV / post-marketing surveillance). They are reported to the FDA through MedWatch.
During an emergency, the provider gives the nurse a verbal order for a medication. Which action should the nurse take?
A. Write down the order, read it back to the provider, and have it signed as soon as possible.
B. Give the medication; verbal orders don't need a signature during an emergency.
C. Have a nursing student write down and accept the order.
D. Accept a verbal order for routine morphine for the next 3 days.
A. Write down the order, read it back to the provider, and have it signed as soon as possible.
Write it carefully and read it back. Verbal orders must still be signed (ideally before giving, always ASAP). Students cannot accept verbal orders, and Schedule II drugs generally require a written order.
A client prescribed sublingual nitroglycerin asks why they can't just swallow the tablet. Which response by the nurse is correct?
A. "Swallowing it would make it work too fast and drop your blood pressure."
B. "Stomach acid makes this medication stronger and more dangerous."
C. "It is only absorbed through the cheek, so place it between your cheek and gum."
D. "Under the tongue, it goes directly into the bloodstream and avoids being inactivated by the liver on its first pass."
D. "Under the tongue, it goes directly into the bloodstream and avoids being inactivated by the liver on its first pass."
First-pass effect: the liver inactivates some drugs on their first pass, so they need a non-enteral route (SL, IV, injection). SL/buccal membranes are highly vascular, so absorption is quick and systemic.
A nurse needs to give an adult client a 2.5 mL intramuscular injection. Which site is preferred?
A. Deltoid
B. Dorsogluteal
C. Abdomen
D. Ventrogluteal
D. Ventrogluteal
Ventrogluteal is preferred for IM injections or volumes over 2 mL. The deltoid holds 2 mL max, dorsogluteal is no longer recommended, and the vastus lateralis is best for infants and toddlers.
A nurse is observing a newly licensed nurse administer medications. Which action shows that the new nurse understands medication error prevention?
A. Removing all medications from their unit-dose wrappers before entering the room
B. Giving a medication, then looking up the usual dose range
C. Relying on another nurse to clarify an unclear prescription
D. Rechecking the prescription when a single dose requires multiple tablets
D. Rechecking the prescription when a single dose requires multiple tablets
Question any dose that needs multiple tablets. Keep unit-dose packages sealed until at the bedside, know the dose range BEFORE giving, and clarify unclear orders with the prescriber.
A client receiving IV penicillin suddenly develops hives, wheezing, stridor, and hypotension. Which action should the nurse take FIRST?
A. Administer diphenhydramine
B. Stop the infusion
C. Administer a corticosteroid
D. Obtain a full set of vital signs
B. Stop the infusion
Anaphylaxis: (1) stop the drug and call Rapid Response, (2) open the airway and give O2 and bronchodilators, (3) epinephrine IM/IV, repeated every 5–15 min, (4) diphenhydramine, (5) corticosteroids, (6) watch for fluid overload.
A client receives a new prescription for alprazolam (Xanax), a Schedule IV drug, and asks how many refills are allowed. Which response is correct?
A. "No refills are allowed."
B. "Unlimited refills for 1 year."
C. "One refill only, with a new prescription each month."
D. "Up to 5 refills within 6 months."
D. "Up to 5 refills within 6 months."
Schedules III and IV: up to 5 refills in 6 months. Schedule IV (Ativan, Valium, Xanax) allows fax and phone orders.
A client looking at a new prescription asks the nurse which part shows how many refills are allowed. Which part should the nurse point to?
A. Superscription
B. Inscription
C. Signature (Sig)
D. Subscription
D. Subscription
Superscription = Rx ("take thou")
Inscription = drug name, dose, quantity
Signature = directions for the patient
Subscription = refills (never left blank).
A client's plasma level of a medication is 100 mg at 0800. The medication has a half-life of 6 hours. If no more doses are given, how much medication should remain at 2000?
A. 50 mg
B. 25 mg
C. 12.5 mg
D. 0 mg
B. 25 mg
0800 to 2000 = 12 hours = 2 half-lives. 100 → 50 (1 t½) → 25 mg (2 t½). It usually takes about 4 half-lives to reach a steady state.
A client with asthma uses both a metered-dose inhaler (MDI) and a dry-powder inhaler (DPI). Which statement by the client indicates a need for further teaching?
A. "I will shake my dry-powder inhaler well before each use."
B. "I will hold my breath for 10 seconds after using my MDI."
C. "I will wait 1 minute between puffs of my MDI."
D. "I will rinse my mouth with water after using my inhalers."
A. "I will shake my dry-powder inhaler well before each use."
Do NOT shake a DPI.
MDI: shake, deep slow breath, hold 10 sec, wait 1 min between puffs. Rinse mouth after both to reduce the risk of fungal infection.
A nurse realizes they gave a client 10 mg of a medication instead of the prescribed 5 mg. After checking the client, which action is appropriate?
A. Document "incident report completed" in the client's medical record.
B. Complete an incident report with an objective account within the facility's timeframe.
C. File a report only if the client experiences harm.
D. Ask the pharmacy to correct the MAR so it matches what was given.
B. Complete an incident report with an objective account within the facility's timeframe.
Incident reports include client ID, drug and dose, time/place, an objective account, who was notified, and actions taken, usually within 24 hr. Never reference the incident report in the medical record. Report ALL errors.
A client taking an antipsychotic medication develops sudden spasms of the neck and face, and their tongue is protruding. Which medication should the nurse expect to administer?
A. Naloxone
B. Acetylcysteine
C. Benztropine
D. Epinephrine
C. Benztropine
This is acute dystonia, an extrapyramidal symptom (EPS) from CNS/mental health drugs. It is treated with anticholinergics (benztropine, diphenhydramine). Acetylcysteine is the antidote for acetaminophen toxicity
A pregnant client asks why drug companies must prove a medication is safe and effective before selling it. The nurse explains this requirement resulted from birth defects caused by thalidomide. Which law is this?
A. Pure Food and Drug Act of 1906
B. Kefauver-Harris Amendment of 1962
C. Controlled Substances Act of 1970
D. Orphan Drug Act of 1983
B. Kefauver-Harris Amendment of 1962
Kefauver-Harris (1962), after thalidomide, required manufacturers to prove effectiveness and safety, report adverse events, and disclose risks in ads. 1906 = accurate labeling; 1938 = established the FDA; 1970 = DEA; 1983 = rare diseases.
A client who avoids pork products for religious reasons is prescribed subcutaneous heparin. What should the nurse do?
A. Give the heparin; it is a synthetic medication.
B. Tell the client the medication is plant-based.
C. Inform the client and notify the provider, because heparin is derived from pig intestines.
D. Change the route to oral so the client can take it.
C. Inform the client and notify the provider, because heparin is derived from pig intestines.
Animal sources: heparin (pig intestines, cow lungs), Premarin (pregnant mare's urine), bovine/porcine hormones. Plant sources: digoxin (foxglove), aspirin (willow bark).