Chapter 04: Drug Interactions and Over-the-Counter Drugs (FREE) Nursing School Test Banks

Chapter 04: Drug Interactions and Over-the-Counter Drugs
Test Bank

MULTIPLE CHOICE

1. A patient has been taking a drug for several years and tells the nurse it is no longer working. The nurse learns that the patient has recently begun taking an over-the-counter antacid medication. What does the nurse suspect is occurring?
a. An adverse drug reaction
b. A drug interaction
c. Drug incompatibility
d. Drug tolerance
ANS: B
Drug interactions are an altered or modified action or effect of a drug as a result of interaction with one or more other drugs. An adverse drug reaction can occur with one or more drugs and has effects ranging from mild to severe toxicity. Drug incompatibility is a chemical reaction of two or more drugs that occurs in vitro. Drug tolerance is the development of reduced response to a medication over time.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 30
TOP: NURSING PROCESS: Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

2. The nurse is preparing to administer two intravenous medications that should not be given using the same IV tubing. The nurse understands that this is because of drug
a. adverse reactions.
b. incompatibility.
c. interactions.
d. potentiation.
ANS: B
Drugs that are incompatible cannot be mixed together in solution and cannot be mixed in a syringe, IV bag, or other artificial environment. Adverse reactions are symptoms occurring from drug effects. Drug interactions occur in vivo. Potentiation is when one drug causes an enhanced response in another drug.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 30
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

3. The nurse is teaching a patient who will begin taking ciprofloxacin. What instruction will the nurse include when teaching this patient about this drug?
a. Do not take this medication with oral contraceptive pills.
b. Take at least 1 hour after or 2 hours before taking antacids.
c. Take in the morning with your multivitamin tablet.
d. Take with milk to reduce gastric upset.
ANS: B
Dairy products, multivitamins, and antacids should be avoided 1 hour before and 2 hours after taking ciprofloxacin because these products contain divalent cations that form a drug complex that prevents absorption of the ciprofloxacin.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 30
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

4. A patient who takes a drug that undergoes gastric absorption will begin taking an opioid analgesic after sustaining an injury in a motor vehicle accident. The nurse will observe the patient closely for which effects?
a. Decreased effects of the first drug
b. Increased effects of the first drug
c. Decreased effects of the narcotic
d. Increased effects of the narcotic
ANS: B
Opioids slow gastric emptying, allowing more time for drugs absorbed in the stomach to be absorbed. The nurse should expect increased effects of the first drug.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 30
TOP: NURSING PROCESS: Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

5. The nurse is preparing to administer erythromycin to a patient who takes digoxin. The nurse will plan to monitor the patient for
a. digoxin toxicity.
b. decreased digoxin effects.
c. erythromycin toxicity.
d. decreased erythromycin effects.
ANS: A
Intestinal flora have the ability to metabolize digoxin, and any drug that destroys or inhibits growth of these gastrointestinal microflora can increase digoxin levels leading to toxicity.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 35
TOP: NURSING PROCESS: Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

6. A young adult female patient who takes a combination oral contraceptive (OCP) will begin taking an antibiotic. When teaching the patient about this medication, the nurse will
a. recommend using a backup method of contraception.
b. suggest that she switch to an injectable form of contraception.
c. tell her that the antibiotic is less effective if she is taking OCPs.
d. tell her the antibiotic has a greater risk for toxicity while taking OCPs.
ANS: A
Gut bacteria are necessary to hydrolyze estrogen conjugates into free estrogens. Concurrent antibiotic administration can alter these bacteria and prevent the optimal absorption and effectiveness of OCPs. A backup contraceptive method is recommended.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 30
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

7. A patient has been taking warfarin (Coumadin), which is highly protein-bound. The patient will begin taking gemfibrozil, which is also highly protein-bound. The nurse will observe the patient closely for
a. decreased effects of warfarin.
b. increased effects of warfarin.
c. decreased effects of gemfibrozil.
d. decreased effects of both drugs.
ANS: B
The addition of a highly protein-bound drug will compete with warfarin for protein- binding sites, releasing more free warfarin into the system, increasing drug effects and increasing the chance of toxicity.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 30
TOP: NURSING PROCESS: Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

8. A patient is taking phenytoin to prevent seizures. The nurse knows that phenytoin is highly protein-bound and has sedative side effects. The nurse reviews the patients chart and notes a low serum albumin. The nurse will notify the provider and observe the patient for which effects?
a. Decreased sedative effects
b. Increased sedative effects
c. Increased seizures
d. No change in effects
ANS: B
Phenytoin is protein-bound. When patients have a low serum albumin, there are fewer protein-binding sites, leaving more free drug in the system. The nurse should expect an increase in sedative side effects.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Pages 30-31
TOP: NURSING PROCESS: Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

9. A patient who takes the anticoagulant warfarin will begin taking the anticonvulsant drug carbamazepine. The nurse reviews the drug information for these drugs and learns that carbamazepine is a hepatic enzyme inducer. The nurse anticipates that the provider will make which dosage adjustment?
a. Decrease the dose of carbamazepine
b. Increase the dose of carbamazepine
c. Decrease the dose of warfarin
d. Increase the dose of warfarin
ANS: D
Carbamazepine is a hepatic enzyme inducer, which can increase drug metabolism. Patients taking both drugs usually need a larger dose of warfarin.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 31
TOP: NURSING PROCESS: Planning
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

10. The nurse is caring for a patient who receives theophylline, which has a narrow therapeutic index. The patient has been receiving cimetidine but will stop taking that drug in 2 days. In 2 days, the nurse will observe the patient closely for
a. decreased effectiveness of theophylline.
b. increased effectiveness of theophylline.
c. decreased toxicity of theophylline.
d. prolonged effectiveness of theophylline.
ANS: B
Cimetidine is an enzyme inhibitor that decreases the metabolism of drugs such as theophylline. If the cimetidine is discontinued, the theophylline dose should be decreased to avoid toxicity. The nurse should observe the patient for increased theophylline effects.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 31
TOP: NURSING PROCESS: Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

11. The nurse is caring for a patient who takes digoxin to treat heart failure. The provider orders furosemide to treat edema. The nurse will monitor the patient for digitalis toxicity because of
a. adverse drug reactions caused by giving these drugs in combination.
b. altered hepatic blood flow caused by the furosemide.
c. changes in reabsorption of water and electrolytes in the kidneys.
d. additive effects of these two drugs given together.
ANS: C
Diuretics such as furosemide promote water and sodium excretion from the renal tubules, especially sodium and potassium. Hypokalemia can result, and this will enhance the action of digoxin, and digitalis toxicity can occur.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 31
TOP: NURSING PROCESS: Evaluation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

12. A patient will receive penicillin to treat an infection. The provider orders probenecid (Probalan), a medication to treat gout, even though the patient does not have gout. Which action by the nurse is correct?
a. Administer the drug since the provider ordered it.
b. Recognize that it is being given prophylactically.
c. Refuse to administer the medication since it is not indicated.
d. Verify that it is being given for its secondary action.
ANS: D
Two or more drugs with the same route of excretion may compete with each other for elimination. Probenecid is given because it inhibits the excretion of penicillin, which may be desirable when the provider wants to prolong the plasma concentration of penicillin. The nurse should always verify an order that may not be clear.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 32
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

13. The nurse is preparing to administer meperidine (Demerol), which is an opioid analgesic, and promethazine (Phenergan), which is an antiemetic and antihistamine. The nurse understands that these drugs are given in combination for which reason?
a. They have antagonistic effects to reduce nausea.
b. They have additive effects to enhance analgesia.
c. They have potentiating effects to decrease an allergic response.
d. They have synergistic effects to increase sedation.
ANS: D
Meperidine and promethazine have a synergistic effect on each other with a clinical effect that is substantially greater than the combined effect of the two.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 33
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

14. The provider has ordered amoxicillin with clavulanate (Augmentin) for a child who has otitis media. The childs parent asks why this drug is necessary when amoxicillin is less expensive. The nurse will explain that clavulanate is added to amoxicillin because it
a. binds with albumin to increase the amount of available amoxicillin.
b. broadens the spectrum of amoxicillin by inhibiting bacterial enzymes.
c. inhibits hepatic blood flow, leading to increased serum drug levels of amoxicillin.
d. inhibits the excretion of amoxicillin by interfering with renal function.
ANS: B
Clavulanate is a bacterial enzyme inhibitor, specifically beta-lactamase, which inactivates amoxicillin. When added to amoxicillin, it broadens the antibacterial spectrum.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 33
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

15. The nurse assesses a patient who is receiving morphine sulfate intravenously using a patient-controlled analgesia pump. The nurse notes somnolence and respiratory depression, which are signs of morphine toxicity. The nurse will prepare to administer naloxone (Narcan) because it
a. has synergistic effects with morphine.
b. is a narcotic agonist.
c. is a narcotic antagonist.
d. potentiates narcotic effects.
ANS: C
Naloxone is a narcotic antagonist, meaning that it reverses the effects of morphine by blocking morphine receptor sites.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 33
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

16. The nurse is teaching a patient about a drug that causes photosensitivity. Which statement by the patient indicates a need for further teaching?
a. I should apply sunscreen with a sun protection factor greater than 15.
b. I should avoid sunlight when possible while taking this drug.
c. I will wear protective clothing when I am outdoors.
d. I will wear sunglasses even while I am indoors.
ANS: D
Drugs that cause photosensitivity make sunburn more likely, so patients should stay out of the sun, wear protective clothing, and use sunscreen with an SPF greater than 15. It is not necessary to wear sunglasses indoors.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 34
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

17. A patient asks the nurse about using over-the-counter (OTC) medications. The nurse will tell the patient that OTC medications
a. are not as effective as prescription medications.
b. are not as safe as prescription medications.
c. have fewer side effects and drug interactions than prescription medications.
d. should be included when listing any medications taken by the patient.
ANS: D
OTC medications should always be included when listing medications because they can cause drug interactions. OTC medications can be as effective and as safe as prescription medications and have as many side effects and adverse reactions.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 36
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

18. A patient who takes warfarin (Coumadin) asks the nurse about taking a medication for headaches. The nurse will recommend which medication?
a. Acetaminophen
b. Aspirin
c. Ibuprofen
d. No medication
ANS: A
Aspirin and NSAIDs can increase the risk of hemorrhage in patients taking anticoagulants. Acetaminophen is safe and may be recommended.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 37
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

19. The nurse is educating the parent of a 20-month-old toddler about over-the-counter (OTC) products to treat cold symptoms. Which statement by the parent indicates understanding of the teaching?
a. I should check with the provider for proper dosing instructions.
b. OTC medications are less potent and have minimal side effects.
c. OTC medications can be given to children younger than 2 years old.
d. Using OTC medications may prevent accurate diagnosis of respiratory illness.
ANS: D
OTC cold medications can mask symptoms and prevent accurate diagnosis of potentially serious illnesses. Their use in children is not recommended.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 37
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

MULTIPLE RESPONSE

1. Which patients are at high risk for drug interactions? (Select all that apply.)
a. Patients who are acutely ill
b. Patients who are taking multiple medications
c. Patients who see several specialists
d. Patients who take supplements and OTC medications
e. Patients who use one pharmacy for several medications
ANS: B, C, D
Patients who have chronic health conditions, take multiple medications, see more than one provider, and use supplements and OTC medications are at higher risk for drug interactions.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 29
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

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