Chapter 8: Drug Interactions and Over-the-Counter Drugs Nursing School Test Banks

Kee: Pharmacology, 7th Edition

Chapter 8: Drug Interactions and Over-the-Counter Drugs

Test Bank

MULTIPLE CHOICE

1. A nurse is monitoring for drug interactions based on which premise about drug interactions?

a.

Drug interactions are undesirable drug effects.

b.

Drug interactions are changes occurring with drug absorption.

c.

Drug interactions are altered effects of a drug from interaction with other drugs.

d.

Drug interactions are reactions that occur in vitro.

ANS: C

Drug interactions are an altered or modified action or effect of a drug as a result of interaction with one or more other drugs.

DIF: Cognitive Level: Comprehension REF: pp. 124-127

TOP: Nursing Process: Analysis

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

2. The nurse is aware that drugs can block, decrease, or increase the actions of another drug. Laxatives can have which effect on drug absorption?

a.

Increase

b.

Decrease

c.

Block

d.

Enhance

ANS: B

Laxatives increase gastric and intestinal emptying, decreasing the time the medication is in contact with the gastric lining and is available for drug absorption.

DIF: Cognitive Level: Application REF: p. 125

TOP: Nursing Process: Analysis

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

3. Narcotics and anticholinergic drugs (atropine-like drugs) decrease gastrointestinal (GI) motility. Decreasing GI motility has what effect on drug absorption?

a.

Increases drug absorption

b.

Decreases drug absorption

c.

Blocks drug absorption

d.

Does not change drug absorption

ANS: A

Because of slower gastric emptying time, drugs have more chance to be absorbed.

DIF: Cognitive Level: Comprehension REF: p. 125

TOP: Nursing Process: Analysis

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

4. A client is taking antacids with an antibiotic. The nurses instructions are based on the fact that antacids such as aluminum hydroxide (Amphojel) can:

a.

increase drug absorption.

b.

slow drug metabolism.

c.

increase drug metabolism.

d.

slow or block drug absorption.

ANS: D

Antacids impair medication absorption by changing the pH and surface area of the gastric lining. Many drugs are formulated to be absorbed in an acidic environment, and antacids make the environment more alkaline.

DIF: Cognitive Level: Application REF: p. 125

TOP: Nursing Process: Analysis

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

5. A client is ordered to receive warfarin (Coumadin), which is highly protein bound. Another medication that is equally highly protein bound is ordered. The nurse anticipates that the dosage will be:

a.

increased for one drug.

b.

increased for both drugs.

c.

decreased for one drug.

d.

decreased for both drugs.

ANS: D

When drugs are equally protein bound, they will vie for receptor sites. More of both drugs will be displaced, allowing for a greater level of medication activity.

DIF: Cognitive Level: Application REF: p. 125

TOP: Nursing Process: Analysis

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

6. The nurse has provided instructions to a client taking diazepam (Valium) for short-term anxiety. Which statement by the client indicates that the client needs additional instruction?

a.

I will avoid drinking alcohol while taking this drug.

b.

I will continue to eat grapefruit while taking this drug.

c.

I will avoid using heavy equipment when taking this drug.

d.

I will contact the healthcare provider if I develop a rash.

ANS: B

Flavanoids are found in grapefruit, and taking diazepam (Valium) with grapefruit may increase drug levels. The other statements are appropriate.

DIF: Cognitive Level: Application REF: p. 126

TOP: Nursing Process: Intervention/Teaching

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

7. Cimetidine (Tagamet) is an enzyme inhibitor for the medication theophylline. Drugs that are enzyme inhibitors:

a.

convert drugs to metabolites.

b.

increase metabolism, promoting drug elimination.

c.

decrease metabolism, promoting an increase in plasma drug concentration.

d.

increase drug action.

ANS: C

An enzyme inhibitor decreases the metabolism of certain drugs.

DIF: Cognitive Level: Application REF: p. 126

TOP: Nursing Process: Analysis

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

8. A client smokes regularly. She takes theophylline (Theo-Dur and others) daily. What is an effect of smoking while on theophylline?

a.

Decrease in theophylline clearance

b.

Increase in theophylline clearance

c.

Increase in the distribution of theophylline

d.

Decrease in the dose for theophylline

ANS: B

Smoking increases hepatic enzyme activity, increasing the clearance of theophylline (Theo-Dur and others). Smokers may need an increased dose of medication.

DIF: Cognitive Level: Comprehension REF: p. 126

TOP: Nursing Process: Analysis

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

9. Some drugs can affect the excretion of other drugs. The antidysrhythmic drug quinidine decreases the excretion of digoxin (Lanoxin). How would the digoxin concentration in the body fluids be affected?

a.

No effect

b.

Decreased

c.

Increased

d.

Unabsorbed

ANS: C

Because the excretion of digoxin (Lanoxin) is decreased, this would allow the digoxin to accumulate in the bloodstream.

DIF: Cognitive Level: Application REF: pp. 126-127

TOP: Nursing Process: Analysis

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

10. A client is receiving two analgesics for pain relief. Two drugs with similar action are administered to achieve which kind of effect?

a.

Additive

b.

Synergistic

c.

Opposing

d.

Antagonistic

ANS: A

Additive drugs include those with similar actions that increase the function of one another when given together.

DIF: Cognitive Level: Comprehension REF: pp. 127-128

TOP: Nursing Process: Analysis

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

11. A client is scheduled for surgery, and an antihistamine and narcotic have been prescribed as preoperative drugs. The antihistamine increases the effect of the narcotic. This is an example of which drug effect?

a.

Additive

b.

Potentiation

c.

Opposing

d.

Antagonistic

ANS: B

Potentiating drugs include those with different actions that when given together increase the function of one another.

DIF: Cognitive Level: Comprehension REF: p. 128

TOP: Nursing Process: Analysis

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

12. A client receives morphine sulfate and demonstrates signs of respiratory depression. The physician orders naloxone (Narcan) to block the effects of the narcotic. When two drugs given concurrently have opposite effects, what kind of pharmacodynamic interactions occur?

a.

Additive

b.

Synergistic

c.

Agonistic

d.

Antagonistic

ANS: D

When two drugs that have opposite effects, or antagonistic effects, are administered together, each drug cancels the effect of the other.

DIF: Cognitive Level: Comprehension REF: pp. 128-130

TOP: Nursing Process: Analysis

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

13. Food is known to increase, decrease, or delay drug absorption. A client has a high serum cholesterol level, and lovastatin (Mevacor) is prescribed. The client is taking the drug at mealtime and asks why this is necessary. What does taking lovastatin with food accomplish?

a.

Decrease in drug absorption

b.

Decrease in drug absorption

c.

Decrease in drug action

d.

Increase in drug excretion

ANS: B

The absorption of the statin medications is increased in the presence of food.

DIF: Cognitive Level: Comprehension REF: p. 130

TOP: Nursing Process: Analysis

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

14. A client is taking tetracycline for acne. It is a drug known to cause photosensitivity. To avoid phototoxicity, the nurse provides client teaching. Which statement by the client indicates a need for more teaching?

a.

I need to avoid excessive sunlight.

b.

I need to use sunscreen when I go out during the day.

c.

I need to wear protective clothing over exposed skin areas in sunlight.

d.

I can stay in the sun for only about 4 hours a day.

ANS: D

Four hours would be too long to be exposed, especially during peak sunlight times.

DIF: Cognitive Level: Application REF: p. 131

TOP: Nursing Process: Intervention/Teaching

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

15. The nurse instructs a client with which condition to avoid taking over-the-counter cough and cold remedies?

a.

High blood cholesterol

b.

Rheumatoid arthritis

c.

Hypotension

d.

Thyroid disease

ANS: D

Clients with heart disease, hypertension, and thyroid disease should avoid taking over-the-counter cough and cold preparations as they may contain sympathomimetics, which may increase blood pressure and cause nervousness, headache, and insomnia.

DIF: Cognitive Level: Application REF: p. 134

TOP: Nursing Process: Intervention/Teaching

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

16. Some medications previously requiring a prescription are now available as over-the-counter (OTC) drugs. Client teaching related to OTC drugs should include:

a.

instructions to take only prescribed drugs.

b.

instructions to report OTC drugs being taken to the healthcare provider.

c.

teaching that herbal drugs can be taken with prescribed drugs.

d.

teaching that all OTC drugs are considered safe.

ANS: B

OTC medications may interact with prescribed medications or may have certain effects that should be evaluated by a healthcare provider.

DIF: Cognitive Level: Application REF: pp. 131-134

TOP: Nursing Process: Analysis

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

17. A client with a history of deep vein thrombosis takes warfarin (Coumadin) daily. He has been experiencing headaches and has been taking over-the-counter pain relievers. The nurse discovers that the client is taking aspirin. Which assessment should the nurse be most attentive to at this time?

a.

The client reports that his gums are bleeding more than usual when he brushes his teeth.

b.

The client complains of constipation.

c.

The client reports that he is unable to sleep at night despite feeling very fatigued.

d.

The nurse notes that the client has a runny nose and some nasal congestion.

ANS: A

Aspirin and warfarin both increase the bleeding time. An early manifestation of this is bleeding from the gums.

DIF: Cognitive Level: Application REF: p. 135

TOP: Nursing Process: Intervention/Implementation

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

18. A client eats a large meal and then takes her medications. Usually food has which effect on drug dissolution and absorption?

a.

Enhances

b.

Increases

c.

Decreases

d.

No effect

ANS: C

Food typically delays drug absorption, although it occasionally has other effects.

DIF: Cognitive Level: Application REF: p. 125

TOP: Nursing Process: Intervention/Implementation

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

19. The nurse is caring for a client who is being treated with aspirin and an oral antidiabetic agent. The nurse anticipates an increased risk of _____ from the interaction between the drugs.

a.

bleeding

b.

clotting

c.

hypoglycemia

d.

hyperglycemia

ANS: C

Oral antidiabetic agents, when taken with aspirin, can increase the risk of hypoglycemia.

DIF: Cognitive Level: Analysis REF: pp. 129-130

TOP: Nursing Process: Intervention/Implementation

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

20. The nurse is caring for a client who is being treated with both isoniazid and phenytoin. The nurse anticipates which result from the interaction between the drugs?

a.

Toxic level of phenytoin

b.

Subnormal level of isoniazid

c.

Toxic level of isoniazid

d.

Subnormal level of phenytoin

ANS: A

Administering isoniazid along with phenytoin may result in phenytoin developing toxic levels.

DIF: Cognitive Level: Analysis REF: pp. 129-130

TOP: Nursing Process: Intervention/Implementation

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

21. The nurse notes that the client has been ordered to receive both aminophylline and dobutamine by IV infusion. The client has one IV access and has been dehydrated. What is the highest priority action on the part of the nurse?

a.

Call the pharmacist for additional information on the medications.

b.

Start a second intravenous access in the clients arm.

c.

Call the physician for orders regarding the medications.

d.

Administer the medications using piggyback tubing.

ANS: C

The drugs are incompatible by intravenous infusion.

DIF: Cognitive Level: Analysis REF: pp. 129 -130

TOP: Nursing Process: Intervention/Implementation

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

MULTIPLE RESPONSE

1. Which drug groups are considered to be over-the-counter (OTC) drug groups? (Select all that apply.)

a.

Herbal products

b.

Laxatives

c.

Antibiotics

d.

Antacids

ANS: A, B, D

Antibiotics require a physicians prescription. The other medications are available OTC.

DIF: Cognitive Level: Comprehension REF: pp. 131-134

TOP: Nursing Process: Analysis

MSC: CONTENT CATEGORY: Physiological Integrity: Pharmacological and Parenteral Therapies

Copyright 2012, 2009, 2006, 2003 by Saunders, an imprint of Elsevier Inc.

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