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?
Note: Credit will be given only if all correct choices and no incorrect choices are
selected.
Standard Text: Select all that apply.
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?
Note: Credit will be given only if all correct choices and no incorrect choices are
selected.
Standard Text: Select all that apply.
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?
Note: Credit will be given only if all correct choices and no incorrect choices are
selected.
Standard Text: Select all that apply.
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?
Note: Credit will be given only if all correct choices and no incorrect choices are
selected.
Standard Text: Select all that apply.
1. Large molecules
2. Ionization
3. Water-soluble agents
4. Alcohol
5. Urea
Correct Answer: 1,2,3
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?
Note: Credit will be given only if all correct choices and no incorrect choices are
selected.
Standard Text: Select all that apply.
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.
Correct Answer: 1,2,3
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?
Note: Credit will be given only if all correct choices and no incorrect choices are
selected.
Standard Text: Select all that apply.
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."
Correct Answer: 2,4,5
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 crosstolerance. 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?
Note: Credit will be given only if all correct choices and no incorrect choices are
selected.
Standard Text: Select all that apply.
1. Abdominal cramping and pain
2. Hypotension
3. Pinpoint pupils
4. Dilated pupils
5. Diaphoresis
Correct Answer: 1,4,5
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?
Note: Credit will be given only if all correct choices and no incorrect choices are
selected.
Standard Text: Select all that apply.
1. Methylphenidate (Ritalin)
2. Nicotine

3. Marijuana
4. Amobarbital (Amytal)
5. Secobarbital (Seconal)
Correct Answer: 1,2,3
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?
Note: Credit will be given only if all correct choices and no incorrect choices are
selected.
Standard Text: Select all that apply.
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."
Correct Answer: 1,2,3
15. A patient has been abusing an antianxiety medication. Which assessment by the nurse
would confirm this is psychological dependence instead of physical dependence?
Note: Credit will be given only if all correct choices and no incorrect choices are
selected.
Standard Text: Select all that apply.
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.
Correct Answer: 1,2,4
16.