final pharm review

Chapter 2

1. The nursing instructor teaches the student nurses about the pharmacological classification of drugs. The instructor evaluates that learning has occurred when the students make which response?

1. "An anti-anginal treats angina."

2. "A calcium channel blocker blocks heart calcium channels."

3. "An antihypertensive lowers blood pressure."

4. "An anticoagulant influences blood clotting."

Correct Answer: 2

Rationale 1: The pharmacological classification addresses a drug's mechanism of action, or how a drug produces its effect in the body. To say that a drug influences blood clotting addresses the therapeutic usefulness of the drug, not the pharmacological classification. To say that a drug treats angina addresses the therapeutic usefulness of the drug, not the pharmacological classification. To say that a drug lowers blood pressure addresses the therapeutic usefulness of the drug, not the pharmacological classification

2. The nurse is providing medication education to a client with hypertension. The nurse teaches the client that the physician ordered a diuretic to decrease the amount of fluid in his body. Which statement best describes the nurse's instruction?

1. The nurse provided appropriate medication education.

2. The nurse explained the drug's mechanism of action.

3. The nurse taught the client about a prototype drug.

4. The nurse explained the consequences of not using the drug.

Correct Answer: 2

Rationale 1: A drug's mechanism of action explains how a drug produces its effect in the body. The nurse did not explain the consequences of not using the drug. The nurse is not teaching the client about a prototype drug. The education was most likely appropriate, but this response is too vague.

3. During pharmacology class, the student nurse asks the nursing instructor how students will ever learn about the individual antibiotic drugs since there are so many. What is the best response by the nursing instructor?

1. "You will learn a little trick called mnemonics."

2. "You will learn how to do a flow chart to enhance memory."

3. "You will learn how to categorize the individual drugs."

4. "You will learn a representative drug from each class."

Correct Answer: 4

Rationale 1: A prototype, or representative, drug is the well-understood drug model from which other drugs in a pharmacological class are compared. Categorizing individual drugs is not the best way to learn about drugs. Using mnemonics is not the best way to learn about drugs. Flow charts are not the best way to learn about drugs.

4. The nurse is teaching a medication class for parents of children with attention-deficit hyperactivity disorder who are receiving stimulant medications. The nurse has reviewed reasons why the medications are restricted. The nurse determines that learning has occurred when the parents make which response(s)?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. "The use of these medications is restricted so that the pharmacies can track the rate of drug abuse in our city."

2. "The use of these medications is restricted because the physician needs to evaluate our child more often."

3. "The use of these medications is restricted because they have the potential for abuse."

4. "The use of these medications is restricted so that the drug companies can make a bigger profit."

5. "The use of these medications is restricted because this is the current law."

Correct Answer: 3,5

Rationale 1: The Controlled Substance Act is the law under which medications with abuse potential are restricted. Stimulant medications are considered controlled substances. More frequent evaluations are a good plan, but this is not the reason for restricted use of stimulant medications. Drug companies do not make a bigger profit when medications are listed as restricted. Pharmacies do not track the rate of drug abuse in cities.

5. The client says to the nurse, "My doctor said my drug is a controlled substance; am I considered an addict?" What is the best response by the nurse?

1. "Are you concerned about becoming an addict? We can discuss this in more detail it you would like to."

2. "You are not an addict; the Drug Enforcement Administration (DEA) restricts the use of drugs with a high potential for abuse."

3. "Why do you ask about becoming an addict? Not many of our clients have asked this question."

4. "You are not an addict, but the Drug Enforcement Administration (DEA) will monitor you for this."

Correct Answer: 2

Rationale 1: Drugs that have a high potential for addiction are considered controlled substances. The Drug Enforcement Administration (DEA) does not monitor clients for addiction when they receive controlled substances. It is premature at this time to ask the client if he is concerned about addiction; there is no information to support an addiction. "Why" questions are considered non-therapeutic because they put the client on the defensive.

6. The client is receiving methadone (Dolophine), a Schedule II drug. The client says to the nurse, "A pharmacist told me his pharmacy must register with the Drug Enforcement Administration (DEA) to give me this drug; will DEA agents be snooping around my house?" What is the best response by the nurse?

1. "It is probably unlikely that Drug Enforcement Administration (DEA) agents will be bothering you."

2. "No, the Drug Enforcement Administration (DEA) restricts drugs that have a high potential for abuse."

3. "No. I think our system should be more like Europe; they have fewer controlled drugs."

4. "That's an interesting question. Are you worried about the Drug Enforcement Administration (DEA)?"

Correct Answer: 2

Rationale 1: The Controlled Substance Act of 1970 restricts the use of drugs that have a high potential for abuse. Hospitals and pharmacies must register with the Drug Enforcement Administration (DEA) to obtain a specific registration number that will enable them to purchase controlled drugs. Telling the client that Drug Enforcement Administration (DEA) agents will "probably" not bother him can lead the client to think DEA agents might bother him. Asking the client if he is worried about the Drug Enforcement Administration (DEA) puts him on the defensive and is non-therapeutic. By saying that our system should be more like Europe's, the nurse is introducing her beliefs and this is non-therapeutic; the client may not agree.

7. During the admission assessment, the client tells the nurse "Sure I smoke a little weed (marijuana) to manage my stress. Doesn't everyone?" What is the best assessment question for the nurse to ask?

1. "What other ways do you think you might use to help you to manage your stress?"

2. "That is a Schedule I drug; aren't you afraid of going to jail for a long time?"

3. "Do you really believe that everyone smokes marijuana to manage stress?"

4. "How often do you smoke marijuana, and how much each time?"

Correct Answer: 4

Rationale 1: The nurse must assess the amount and frequency of any drug the client uses, including illegal drugs. Asking the client if he really believes something is not an assessment question, and can lead to an argument with the client. Stress management is not the main concern during the admission assessment. Asking the client if he is afraid of going to jail is not an assessment question, and is not the issue during the admission assessment

8. The mother of an adolescent receiving methylphenidate (Concerta) for attention-deficit hyperactivity disorder tells the nurse that her son is better and asks why she can't just get refills on the prescription. What is the best response by the nurse?

1. "Just drop by and I will get a prescription for you without seeing your son."

2. "We can't do that; maybe you can find another doctor's office that will do it."

3. "The law does not allow us to give you refills on this medication."

4. "The medication can be addictive so your son needs a monthly medical evaluation."

Correct Answer: 4

Rationale 1: Telling the mother the reason for monthly evaluations is a therapeutic response that is correct and answers the mother's question. Schedule II medications cannot be refilled without the client being seen by the physician. Telling the mother about the law is accurate, but it is a non-therapeutic response; the mother needs an explanation. Referring the mother to another office is non-therapeutic and implies that other medical offices violate the law.

9. The nurse provides medication education to a client with terminal cancer. The physician has ordered morphine (MS Contin), a Schedule II drug, for the client. The nurse determines that learning has occurred when the client makes which statement?

1. "I need to call the office for a refill before my medication runs out."

2. "This drug is addictive so I should only take it when my pain becomes severe."

3. "Maybe my doctor could change me to a Schedule IV drug."

4. "I need to see my doctor before my prescription runs out so I can get a refill."

Correct Answer: 4

Rationale 1: Schedule II drugs cannot be refilled without the client seeing the physician. Not taking pain medication until the pain becomes severe is an inappropriate use of pain medication for a patient with terminal cancer. The client must see the physician for a refill. A Schedule IV drug may not effectively relieve the client's pain.

10. Which type of classification system is being used when drugs are grouped together because they help treat a particular disease or condition?

1. Therapeutic

2. Mechanism of action

3. Chemical

4. Pharmacological

Correct Answer: 1

Rationale 1: Therapeutic classification is based on the drug's usefulness in treating a particular disease. Pharmacological classification addresses a drug's mechanism of action.

11. While discussing antihypertensives, the instructor states that a particular agent causes a reduction in blood pressure by blocking receptor sites. The instructor is describing which of the following?

1. Drugdrug interaction

2. Adverse effects

3. Indication

4. Mechanism of action

Correct Answer: 4

Rationale 1: The instructor is describing how a drug produces an effect within the body, which is known as the mechanism of action. Adverse effects are what can result from drug use, not a description of how the drug works. Indications are the reasons the drug is being used, and drugdrug interactions refer to the effects of multiple drug use.

12. Which drug has the highest dependency potential?

1. Acetaminophen

2. Codeine

3. Heroin

4. Diazepam

Correct Answer: 3

Rationale 1: Heroin is a Schedule I drug, and has the highest potential for abuse, physical dependence, and psychological dependence of the drugs listed.

13. The presence of muscle tremors following drug cessation would most accurately be associated with which of the following?

1. Adverse effect

2. Psychological dependence

3. Therapeutic effect

4. Physical dependence

Correct Answer: 4

Rationale 1: The presence of physical withdrawal symptoms (muscle tremors) is seen when a person is physically dependent on a drug and the drug is removed. With psychological dependence, few physical signs are seen. Therapeutic effects are seen while drugs are being used, not after they have been removed.

14. A physician may telephone in an order for which of the following?

1. Morphine

2. Marijuana

3. Cocaine

4. Codeine

Correct Answer: 4

Rationale 1: Schedule I and II drugs cannot be ordered via the telephone. Marijuana is a Schedule I drug, and cocaine and morphine are Schedule II drugs, while codeine is a Schedule III drug.

Chapter 4

1. The nurse is conducting medication education for patients with hypertension. The focus of the education is on enhancing the absorption of their medications. The nurse determines that learning has occurred when the patients make which statement?

1. "We can safely take the drug for at least 6 months beyond the expiration date."

2. "We don't need to worry about storage of the drug, it won't lose potency."

3. "We should not take our medications with milk or dairy products."

4. "We need to be careful about taking the medication with certain foods."

Correct Answer: 4

Rationale 1: Food can alter the absorption of many medications. Storage can affect the medication's strength and may affect how it responds in the body. There are many more foods that will alter the absorption of medications other than milk and dairy products. Patients should be taught to avoid taking medications beyond the expiration date.

2. The physician ordered a loading dose of medication for the patient; it is to be followed by a lower dose. When the patient receives the lower dose, she says to the nurse, "I think my doctor made a mistake; my medication dose is too low." What is the best response by the nurse?

1. "The initial dose shortened the half-life, so the medication would work more quickly."

2. "We always give medications this way; the doctor did not make a mistake."

3. "You had a larger dose initially so that the medication would work more quickly."

4. "Giving a larger dose initially will reduce the chance of side effects."

Correct Answer: 3

Rationale 1: Loading doses of medications are used to quickly induce a therapeutic response. Loading doses do not shorten the half-life of a drug. Not all medications are initiated with a loading dose. Loading doses do not reduce the occurrence of side effects.

3. The patient has meningitis. The physician initially prescribed a water-soluble drug. Another physician changed the order to a lipid-soluble drug. The patient is confused about this. Which plan best resolves the patient's concern?

1. Teach the patient that lipid-soluble drugs are better because of protein binding.

2. Teach the patient that lipid-soluble drugs are more effective in treating his illness.

3. Teach the patient that lipid-soluble drugs are better because they have fewer side effects.

4. Teach the patient that lipid-soluble drugs are more effective because they are excreted at a slower rate.

Correct Answer: 2

Rationale 1: Drug molecules that are lipid soluble will usually pass through plasma membranes by simple diffusion and more easily reach their target cells. Lipid-soluble drugs do not necessarily have fewer side effects. Not all lipid-soluble drugs are protein bound. Lipid solubility does not affect drug excretion.

4. The patient is malnourished and has a low serum albumin. The physician has ordered aspirin, a highly protein-bound drug, for the patient. Which evaluation by the nurse best describes the effect this will have on the patient?

1. The patient will be at risk to experience a decreased effectiveness of the drug.

2. The patient will be at risk to experience toxic effects of the drug.

3. The patient's kidneys will excrete the drug at a faster rate.

4. The patient's serum globulin is more important than serum albumin.

Correct Answer: 2

Rationale 1: Aspirin is a protein-bound drug. With a low albumin, there is less protein for aspirin to bind with, making more free drug available. There may be toxic, not decreased, effects from the drug because there is less protein for aspirin to bind with and more free drug available. The kidney will not be able to balance the amount of the drug and excrete it at a faster rate. Serum albumin plays a major role, more than serum globulin.

5. The patient is complaining of a severe headache. The physician orders aspirin. Which action by the nurse will result in the fastest relief of the patient's headache?

1. Administer the aspirin with an alkaline food, like cottage cheese.

2. Administer the aspirin in an enteric-coated formulation.

3. Administer the aspirin with a high-fat food, like peanut butter.

4. Administer the aspirin on an empty stomach.

Correct Answer: 4

Rationale 1: Acids such as aspirin are best absorbed in the acidic environment of the stomach, so the aspirin should be administered on an empty stomach. Administering the aspirin in an enteric-coated formulation will lessen gastrointestinal irritation, but will increase the time for the drug's effect. Peanut butter and cottage cheese will slow absorption and increase the time for the drug's effect.

6. The patient is receiving lithium (Eskalith) and asks the nurse why he has to have blood drawn so often. What is the best response by the nurse?

1. "To detect side effects before they become a problem."

2. "To be sure the medication is working properly."

3. "To determine if your body is responding as it should."

4. "To be sure you have the correct amount of medication in your system."

Correct Answer: 4

Rationale 1: Medications, such as lithium (Eskalith), with a narrow therapeutic range must be monitored with lab tests; this is how the correct dosage is determined. A lab test will not confirm that the medication is working properly; assessment of the patient confirms this. Body response to the medication is best determined by patient assessment. Side effects are best determined by patient assessment.

7. The nursing instructor is teaching pharmacology to student nurses. What will the nursing instructor include as the four major components of pharmacokinetics?



1. How drugs move from the site of administration to circulating fluids

2. How drugs are converted to a form that is easily removed from the body

3. How drugs change body illnesses and pathogens

4. How drugs are transported throughout the body

5. How drugs are removed from the body

Correct Answer: 1,2,4,5

Rationale 1: Absorption describes how drugs move from the site of administration to circulating fluids. Distribution describes how drugs are transported throughout the body. Metabolism describes how drugs are converted to a form that is easily removed from the body. Excretion describes how drugs are removed from the body. Pharmacodynamics describes how drugs change body illnesses and pathogens.

8. The patient tells the nurse that he is on many medications, and questions how they all get to the right places. What is the best response by the nurse?



1. "It depends on how much protein you have in your body."

2. "It depends on the health of your kidneys."

3. "It depends on whether they are fat based or water based."

4. "It depends on the amount of blood flow to your body tissues."

5. "It depends on the health of your liver."

Correct Answer: 1,3,4

Rationale 1: Distribution of drugs depends on the amount of blood flow to body tissues, the lipid solubility of the drug, and protein binding. The health of the liver refers to metabolism, not distribution. The health of the kidneys refers to excretion, not distribution.

9. The patient receives a drug that is excreted in the bile. What will the best nursing assessment of the effect of this drug on the patient include?

1. The effect of the drug will be a prolonged action.

2. The effect of the drug will be increased side effects.

3. The effect of the drug will be decreased side effects.

4. The effect of the drug will be decreased.

Correct Answer: 1

Rationale 1: Most bile is circulated back to the liver so drugs secreted into the bile will be recirculated numerous times with the bile, resulting in a prolonged action of the drug. Bile-excreted drugs do not have a decreased effect, nor are side effects decreased. Side effects may or may not be increased; this is dose dependent.

10. The nurse administers medications by various routes of delivery. The nurse recognizes which route of administration as requiring higher dosages of drugs to achieve a therapeutic effect?

1. Intravenous route

2. Oral route

3. Rectal route

4. Sublingual route

Correct Answer: 2

Rationale 1: Oral medications pass into the hepatoportal circulation and may be completely metabolized before reaching the general circulation. This so-called "first pass effect" may necessitate the use of higher dosages of oral medications to achieve a therapeutic effect. None of the other routes, sublingual, rectal, or intravenous, are affected by the "first-pass effect."

11. Enzymatic activity that changes a medication into a less active form is an example of

1. pharmacodynamics.

2. active transport.

3. pharmacokinetics.

4. diffusion.

Correct Answer: 3

Rationale 1: Pharmacokinetics describes how drugs are handled within the body. Pharmacodynamics involves how drugs change the body. Diffusion is the movement of a chemical from an area of higher concentration to an area of lower concentration. Active transport is the movement of a chemical against concentration or gradient. (p. 37)

12. Which of the following are the four categories of pharmacokinetics?

1. Diffusion, active transport, interspersing, and storage

2. Ingestion, metabolism, interspersing, and excretion

3. Absorption, distribution, metabolism, and excretion

4. Ingestion, settling, movement, and storage

Correct Answer: 3

Rationale 1: The four categories of pharmacokinetics are absorption, distribution, metabolism, and excretion.

13. Aspirin is ionized as it enters the small intestine. Which statement is accurate regarding the absorption of aspirin in the small intestine?

1. Absorption is decreased.

2. Absorption is increased.

3. Ionization has nothing to do with the absorption rate.

4. Aspirin must travel past the small intestine for absorption to occur.

Correct Answer: 1

Rationale 1: The small intestine is a more alkaline environment, which facilitates the absorption of basic drugs. Aspirin is an acidic drug that is ionized in the small intestine, and will have lower absorption rates. Higher rates of absorption occur in the stomach (an acidic environment).

14. Which statement regarding medication distribution within the body is accurate?

1. The bloodbrain barrier inhibits rapid crossing of all medications.

2. Body organs with high levels of blood flow are more difficult organs to which to deliver drugs.

3. Medications that are lipid-soluble are more completely distributed.

4. Drugprotein complexes must form prior to crossing capillary membranes.

Correct Answer: 3

Rationale 1: Lipid-soluble medications are absorbed and distributed quicker and more quickly than those that are not. Body organs with low levels of blood flow are more difficult organs to which to deliver drugs. When medications bind to proteins, their size increases, preventing them from passing through capillary membranes. Some medications (sedatives) are able to rapidly cross the bloodbrain barrier. (pp. 3940)

15. Which statement is accurate regarding medications that end up being secreted in bile?

1. All medications secreted in bile are excreted in the feces.

2. Some medications are excreted in the feces while others can be recirculated to the liver many times.

3. Most medications secreted in bile are metabolized in the gallbladder.

4. Generally, medications are not secreted in the bile.

Correct Answer: 2

Rationale 1: Most bile is circulated back to the liver by enterohepatic circulation, where medications are metabolized in the liver. Some bile (and medications within) is excreted in the feces.

16. The nurse is teaching a patient the importance of taking the medication as prescribed. Patient teaching is guided by the nurse's knowledge of which principles of pharmacokinetics?



1. A medication taken by injection must cross the membranes of the gastrointestinal tract to get to the blood stream before it can be distributed throughout the body.

2. A drug may be exposed to several physiological processes while en route to target cells.

3. Liver enzymes may chemically change the drug.

4. Excretion organs such as kidneys and intestines must be healthy enough to eliminate the drug.

5. Many processes to which drugs are exposed are destructive, thereby helping facilitate the drug's movement throughout the body.

Correct Answer: 2,3,4,5

17. The nurse is reviewing the role of diffusion in the distribution of medications. Drugs that cannot be distributed by simple diffusion include those with which characteristics?



1. Large molecules

2. Ionization

3. Water-soluble agents

4. Alcohol

5. Urea


18. The nurse is preparing an intramuscular (IM) injection for a patient with strep throat. What principles of absorption may have guided the health care provider's decision to order the medication by IM route?



1. IM drugs are rapidly absorbed.

2. IM drugs bypass the gastrointestinal tract, resulting in increased absorption.

3. IM drugs avoid drug?drug and food?drug interactions, which can decrease absorption.

4. IM drugs have the ability to accumulate in the muscle and may remain in the body for an extended amount of time.

5. IM drugs bypass the gastrointestinal tract and are delivered to the small intestine, where most medications are rapidly absorbed.


Chapter 11

1. The nurse is managing care for a group of substance abusers. The patients have completed group education about the disease of addiction. The nurse determines that learning has occurred when the patients make which statements?



1. "A heroin addict can die from heroin withdrawal."

2. "Substance abuse depends on complex variables."

3. "Most addicts became addicted from pain medication in a hospital."

4. "Addiction includes a compulsion to use a mood-altering substance."

5. "There is most likely a genetic component to addiction."


Rationale 1: Addiction is an overwhelming compulsion that drives someone to repetitive drug-taking behavior, despite serious health and social consequences. Substance abuse depends on multiple, complex, interacting variables. Children of alcoholic parents are four times more likely to become alcoholics than children of nonalcoholic parents. Prescription drugs rarely cause addiction when used according to accepted medical protocols. While extremely unpleasant, withdrawal from opioids is not life threatening.

2. The adolescent patient is in a drug rehabilitation program. The mother of this patient says to the nurse, "The doctor said my son has a physical addiction to alcohol. What does this mean?" What is the best response by the nurse?

1. "His brain remembers the euphoria he had with alcohol, and he has a craving to return to it."

2. "He will have an intense craving for alcohol; this is best managed in group therapy."

3. "His body is used to alcohol; he will have specific withdrawal symptoms when it is stopped."

4. "He will have feelings of depression when stopping alcohol; we need to monitor him for suicide."

Correct Answer: 3

Rationale 1: Over time, the body's cells become accustomed to the presence of the unnatural substance. Specific, physical withdrawal symptoms will occur; the patient needs to be medically withdrawn from the substance. Psychological dependence, or craving, does not involve physical withdrawal symptoms. Alcohol does produce euphoria, but a craving for the substance is not a medical issue. Depression may accompany physical withdrawal, but physical signs are what require medical management.

3. The patient has an extensive history of alcoholism. He is having coronary bypass surgery. While administering anesthesia, the certified nurse anesthetist notes that the patient requires higher-than-usual amounts of the drug. The nurse correctly evaluates this response as what phenomenon?

1. The nurse anesthetist most likely did not calculate the correct amount of anesthesia for this patient.

2. The patient has developed a paradoxical reaction to the anesthesia, and will require a different drug.

3. The patient has developed a resistance to the anesthesia, so it will not work very well.

4. The patient had developed cross-tolerance to the anesthesia, and will require higher amounts.

Correct Answer: 4

Rationale 1: With chronic alcohol use, the liver adapts and metabolizes alcohol at a faster rate. More of the substance is required to achieve the same effect. This is a phenomenon known as cross-tolerance. This patient has a tolerance to alcohol, so he will require additional anesthesia for surgery since both drugs are CNS depressants. There is no evidence to support that the nurse anesthetist incorrectly calculated the anesthesia dose. Resistance refers to the immune system and infections, and should not be used interchangeably with tolerance. Paradoxical refers to the opposite response; in this case, the patient would have become very excitable; there is no evidence of this.

4. The patient comes to the emergency department and tells the nurse, "I have been off my drugs for 3 days." The nurse assesses the patient for withdrawal symptoms associated with the category of drug used. Withdrawal from which drug, if taken by the patient, should cause the nurse the most concern?

1. Heroin

2. Alprazolam (Xanax)

3. Cocaine

4. Marijuana

Correct Answer: 2

Rationale 1: Alprazolam (Xanax) is a benzodiazepine. This drug, which is a central nervous system (CNS) depressant, will likely lead to the most life-threatening withdrawal symptoms in a patient who has stopped taking it. Withdrawal from heroin is very unpleasant, but it is not life threatening. Withdrawal from cocaine is uncomfortable, but it is not life threatening. There is virtually no withdrawal from marijuana.

Rationale 2: Alprazolam (Xanax) is a benzodiazepine. This drug, which is a central nervous system (CNS) depressant, will likely lead to the most life-threatening withdrawal symptoms in a patient who has stopped taking it. Withdrawal from heroin is very unpleasant, but it is not life threatening. Withdrawal from cocaine is uncomfortable, but it is not life threatening. There is virtually no withdrawal from marijuana.

5. The patient is withdrawing from opioids. Which symptom best describe(s) the results of the nurse's assessment?



1. Abdominal cramping and pain

2. Hypotension

3. Pinpoint pupils

4. Dilated pupils

5. Diaphoresis


Rationale 1: Signs of opioid withdrawal include diaphoresis, restlessness, dilated pupils, hypertension, and abdominal cramps and pain. The pupils will be dilated during opioid withdrawal, but will appear as pinpoints when the patient is using opioids. The blood pressure will be elevated during opioid withdrawal, but will be decreased when the patient is using opioids.

6. The patient had been abusing cocaine for several years. Recently, the patient snorted cocaine that was much purer than was thought, resulting in an overdose. The patient died in the emergency department. What does the nurse recognize as the most likely cause of death?

1. Cardiac arrest

2. Rhabdomyolysis

3. Impurities in the cocaine

4. Bowel ischemia

Correct Answer: 1

Rationale 1: Overdose of cocaine can result in dysrhythmias, convulsions, stroke, or death due to cardiac and respiratory arrest. Impurities in the cocaine would not have resulted in the death of the patient. Bowel ischemia would not occur with a cocaine overdose. Rhabdomyolysis would not occur with a cocaine overdose.

7. The patient has been prescribed disulfiram (Antabuse) to discourage a return to drinking alcohol. The patient tells the nurse that after stopping disulfiram (Antabuse) for a week, he returned to drinking alcohol. What will the nurse most likely assess in the patient?

1. Headache, nausea, and vomiting

2. Confusion and fine tremors

3. An absence of symptoms, as the drug was discontinued

4. Severe hyperglycemia and dry skin

Correct Answer: 1

Rationale 1: If alcohol is consumed while taking disulfiram (Antabuse), the patient becomes violently ill within 5 to 10 minutes. Symptoms include headache, shortness of breath, nausea, and vomiting. Alcohol sensitivity continues for up to 2 weeks after disulfiram (Antabuse) has been discontinued. Severe hypoglycemia and dry skin are not side effects of the combined use of alcohol and disulfiram (Antabuse). Confusion and fine tremors are not side effects of the combined use of alcohol and disulfiram (Antabuse).

8. The patient is a 10-year-old child admitted to the emergency department after "huffing" gasoline. The physician suspects mild brain damage. What signs will the nurse teach the parents to observe for after they take the child home?

1. Slurred speech, memory loss, and personality changes

2. Depression, cold extremities, and dyspnea

3. Nausea, vomiting, and dizziness

4. Irregular pulse, fainting, and anger

Correct Answer: 1

Rationale 1: Children can die after a single episode of "huffing" a volatile chemical, or they may suffer brain damage. Brain damage may be manifested as slurred or slow speech, memory loss, or personality changes. Irregular pulse, fainting, and anger are not signs of brain damage. Depression, cold extremities, and dyspnea are not signs of brain damage. Nausea, vomiting, and dizziness are not signs of brain damage.

9. When an individual wants to stop using a drug but cant, she would be suffering from

1. psychological dependence.

2. substance dependence.

3. physical dependence.

4. withdrawal syndrome.

Correct Answer: 2

Rationale 1: The question does not indicate the presence or lack of symptoms. Therefore, the more general term substance dependence is the best choice.

10. The nurse would expect to see which of the following withdrawal symptoms from an alcoholic patient?

1. Lethargy, constipation, light sensitivity, and weight loss

2. Anxiety, seizures, hearing loss, and alopecia

3. Tremors, anxiety, confusion, and delirium

4. Abdominal pain, chills, pupil dilation, and lethargy

Correct Answer: 3

Rationale 1: Common withdrawal symptoms associated with alcohol include tremors, fatigue, anxiety, abdominal cramping, hallucinations, confusion, seizures, and delirium

11. A hospice patient has been receiving oral pain medication for several weeks. The patient started with 4 mg of the drug, and each week has had to increase the amount by 23 mg to obtain adequate pain relief. The nurse recognizes that the patient

1. has developed immunity to the drug.

2. has developed a tolerance to the drug.

3. has developed a physiologic addiction to the drug.

4. has developed a psychological addiction to the drug.

Correct Answer: 3

Rationale 1: Drug tolerance occurs when the body adapts to a substance after repeated administration. Although addictions are possible, the situation presented best describes drug tolerance, not addiction. Drug immunity is a term that is often confused with drug tolerance. Drug immunity is more appropriately used when discussing the immune system.

12. A patient suffering from tachycardia and palpitations would most likely be experiencing the signs of drug toxicity from which of the following?

1. Nicotine

2. Alcohol

3. Benzodiazepines

4. Marijuana

Correct Answer: 1

Rationale 1: Signs of nicotine toxicity include heart palpitations, tachydysrhythmias, confusion, depression, and seizures.

13. A nurse is preparing to admit a patient suspected of overdose. The nurse knows to suspect which drugs as being the most commonly abused?



1. Methylphenidate (Ritalin)

2. Nicotine

3. Marijuana

4. Amobarbital (Amytal)

5. Secobarbital (Seconal)


14. The nurse is reinforcing factors that contribute to addiction to a group of patients recovering from addiction and their family members. Which statement made by a patient or family member would indicate the need for additional teaching?



1. "I'm not likely to have any more problems with addiction since neither of my parents had a problem with addiction."

2. "I can still see my friends as long as I stay away from alcohol."

3. "I don't want to become addicted like my husband did. I'm never going to take any kind of drug unless I absolutely have to."

4. "I realize now that I was just looking for ways to help me feel good about myself."

5. "After a while, it just seemed even though I was not in pain, I would still want to take the pain pills."


15. A patient has been abusing an antianxiety medication. Which assessment by the nurse would confirm this is psychological dependence instead of physical dependence?



1. The patient's history reveals the long-term use of high doses of an antianxiety medication.

2. The patient describes the "need" to use the antianxiety medication despite not feeling anxious.

3. The patient describes feeling nauseous with abdominal cramping.

4. The patient tells you her family has "disowned" her because of her need for the antianxiety medication.

5. The patient complains she has not slept in days, feels anxious, and tired.


16.

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