ATI Pharmacology Across the Lifespan
Test Questions with Correct & Verified Marking Scheme 2023-2024.
1. Pregnancy and Renal pharmacokinetics
Answer: renal blood flow doubles, GFR increased by 3rd trimester and this will accelerate drug
clearance, so there needs to be an increase in dosage
2. Pregnancy and Hepatic metabolism pharmacokinetics
Answer: Increases for some drugs and an increased dosage may be needed to time schedule
compressed (give dose more frequently)
3. Pregnancy and GI system pharmacokinetics
Answer: Tone and motility are decreased (may have problems with constipation), takes longer
for contents to pass...leads to more time available for drugs to absorb and to go through
enterohepatic recirculation. May have prolonged drug effects and there may be a need to reduce
dosage
4. Placental drug transfer
Answer: Assume that all drugs cross the placenta! This is more prevalent with lipid soluble
drugs but is more difficult with ionized, highly polar protein bound drugs.
5. Teratogenesis
Answer: Produces birth defects; physical defects occur between 1-8 weeks gestation; effect of a
teratogen is highly dependent on when the drug/substance was given during the pregnancy
6. Breast feeding and medication
Answer: Use the lowest effective dose for the shortest time, lipid soluble drugs are the ones to
worry most about, avoid drugs with long half-lives, and dose immediately after feeding
7. Pharmacokinetics and infants
Answer: there is an increased sensitivity related to five immature processes in infants (drug
absorption, renal excretion, hepatic metabolism, protein binding, blood-brain barrier).
8. Drug distribution in infants
Answer: protein binding is limited in infants bc of low albumin levels and competition for
binding site so the result is that there are high free drug levels which intensifies the
effects...dosages must be reduced
9. Geriatric prescribing principles
Answer: secure a thorough drug history, choose the simplest regimen and only make one change
at a time! Promote adherence to regimen
10. Absorption and older adults
Answer: There is decreased acidity, surface area, and GI motility, gastric emptying is delayed
but % of oral dose absorbed does not change
11. Distribution in older adults
Answer: there is an increased percentage of body fat which increases storage for lipid soluble
drugs so their half-lives increase, there is a decreased total body water so water soluble drugs in
smaller volume will lead to more intense effect and there is a reduction in albumin so drugs have
fewer binding sites and there will be more drug in plasma
12. metabolism and older adults
Answer: decreased hepatic metabolism r/t blood flow, less liver mass, and decreased activity of
hepatic enzymes. This leads to an increased half-life of drugs.
13. excretion and older adults
Answer: there is a reduction in renal excretion, leads to decreased ability to conserve sodium
and concentrate urine
14. promoting adherence in older adults
Answer: encourage use of pill boxes, family support, written schedule, keep in visible place
where routine is consistent, journaling, putting drugs into simple terms, literacy problems that
may need to be addressed
15. An older adult patient will often experience a reduction in the stomach's ability to produce
gastric acid. The nurse knows that this change:
A. causes delayed gastric emptying.
B. results in an increase in gastric acidity.
C. causes decreased intestinal absorption of medications.
D. may alter absorption of drugs that require acidity to dissolve.
Answer: D. may alter absorption of drugs that require acidity to dissolve.
Gastric acidity is reduced in the elderly and may alter the absorption of drugs that require high
acidity to dissolve.
16. While assessing the medications taken by an elderly woman, you determine that she is
experiencing polypharmacy. This indicates that she:
A. takes only prescription medications for her illnesses.
B. takes medications for a single illness several times a day.
C. takes multiple medications for several different illnesses.
D. risks problems only if she also takes over-the-counter medications.
Answer: C. takes multiple medications for several different illnesses.
Polypharmacy is defined as treatment with multiple drugs and is often a factor in drug therapy in
the elderly
17. When considering the effect of renal function on drug excretion, the nurse recalls that adult
levels of renal function are achieved by what age?
A. 1 month of age
B. 3 months of age
C. 6 months of age
D. 12 months of age
Answer: D. 12 months of age
Adult levels of renal function are achieved by 1 year of age.
18. When considering drug dosages for the older adult, the nurse recognizes that which is an agerelated change that may affect pharmacokinetics?
A. Decreased body fat
B. Decreased GI motility
C. Increased hepatic blood flow
D. Increased serum albumin
Answer: B. Decreased GI motility
Age-related changes include decreased GI motility, increased body fat, decreased hepatic blood
flow, and decreased serum albumin.
19. When considering the age-related changes in the kidney of the older adult, the nurse recalls
that which drug response is possible?
A. Drug half-life is lengthened.
B. Drug half-life is shortened.
C. Drug excretion is accelerated.
D. Drug effect is diminished.
Answer: A. Drug half-life is lengthened.
Decreased renal excretion causes drug accumulation and is the most important cause of adverse
drug reactions in the elderly.
20. When evaluating renal function in the elderly, the nurse knows that the best indicator of renal
function is:
A. blood urea nitrogen (BUN).
B. serum creatinine.
C. creatinine clearance.
D. uric acid.
Answer: C. creatinine clearance.
Creatinine clearance is the proper indicator of renal function in an elderly person; the serum
creatinine level does not reflect kidney function in the elderly because the source of creatinine,
lean muscle mass, is reduced in parallel with the decline of kidney function. Therefore, the
creatinine level may appear to be "normal" even when renal function is reduced.
21. When considering the physiologic changes that affect pharmacokinetics in the elderly, the
nurse recognizes that which factors occur? Select all that apply.
A. Decreased gastric pH
B. Increased gastric pH
C. Decreased body fat
D. Increased body fat
E. Decreased hepatic mass
F. Increased hepatic mass
Answer: B. Increased gastric pH
D. Increased body fat
E. Decreased hepatic mass
22. Several physiologic changes affect the absorption, distribution, metabolism, and excretion of
drugs in the elderly. The correct
Answer: In the elderly, increased body fat, increased gastric pH, and decreased hepatic mass
affect drug absorption, distribution, metabolism, and excretion. These changes can lead to altered
drug efficacy and increased risk of adverse effects.
23. Which factors contribute to intentional noncompliance in the elderly? Select all that apply.
A. Taking several drugs throughout the day
B. Unpleasant side effects
C. Problems with manual dexterity
D. Forgetfulness
E. Failure to understand instructions
F. Believing that the prescribed dose is not needed
Answer: B. Unpleasant side effects
F. Believing that the prescribed dose is not needed
Unpleasant side effects and believing that the prescribed dose is not needed are two factors that
contribute to intentional noncompliance. The other factors listed may contribute to unintentional
noncompliance.
24. A nurse at an obstetric clinic is caring for a client who has just had a positive pregnancy test.
The client tells the nurse that she has epilepsy and is taking phenobarbital to control seizure
activity. Which of the following information should the nurse provide to the client?
A. "You will not be able to take phenobarbital while you are pregnant."
B. "You should avoid taking folic acid during your pregnancy because you have epilepsy."
C. "You will need to come to the clinic so the provider can monitor your blood levels to adjust
your dosage."
D. "You will not be able to breastfeed your child while taking phenobarbital."
Answer: C. "You will need to come to the clinic so the provider can monitor your blood levels to
adjust your dosage."
Rationale:
Phenobarbital is commonly used to manage epilepsy, but during pregnancy, physiological
changes can alter drug metabolism and clearance. This can affect the effectiveness of the
medication, making it crucial for healthcare providers to monitor blood levels regularly.
Adjusting the dosage as needed helps ensure effective seizure control while minimizing potential
risks to the mother and fetus.
A is incorrect because phenobarbital can be used during pregnancy, but it must be carefully
monitored.
B is incorrect; in fact, folic acid is recommended for women with epilepsy during pregnancy to
help reduce the risk of neural tube defects.
D is misleading; while phenobarbital does pass into breast milk, many mothers can still
breastfeed while taking it, provided they are monitored by their healthcare provider.
25. A nurse is preparing to administer sublingual nitroglycerin to a client who has chest pain. The
client asks the nurse, " Why am I placing the medication under my tongue instead of swallowing
it with some water?" Which off the following responses should the nurse make?
A. "There are no oral forms of nitroglycerin for you to swallow."
B. "The sublingual form of the medication will not be effective if you swallow it."
C. "The sublingual form of the medication will last longer in your system than the oral form."
D. "There are no adverse effects with the sublingual form of the medication."
Answer: B. "The sublingual form of the medication will not be effective if you swallow it."
Rationale:
Sublingual nitroglycerin is designed to be absorbed directly into the bloodstream through the
mucous membranes under the tongue. This route allows for rapid onset of action, which is
critical in treating acute chest pain or angina. If swallowed, the medication would pass through
the gastrointestinal tract and be metabolized by the liver, significantly delaying its effect and
reducing its efficacy.
A is incorrect because there are oral forms of nitroglycerin, but they are not used for immediate
relief of chest pain.
C is incorrect; sublingual nitroglycerin typically has a shorter duration of action compared to
some oral formulations.
D is misleading; while sublingual nitroglycerin is effective, it can still have adverse effects, such
as headache or hypotension, and these should be communicated to the patient.
26. A nurse is preparing to administer medications to an older adult client. The nurse should
identify that which of the following physiologic changes can affect the DISTRIBUTION of
medications in the older adult client?
A. Decreased renal blood flow
B. Increased gastric pH
C. Decreased hepatic mass
D. Increased body fat
Answer: D. Increased body fat
Rationale:
In older adults, increased body fat can significantly affect the distribution of lipophilic (fatsoluble) medications. As body fat increases, these medications have a larger volume of
distribution, which can lead to prolonged effects and a longer half-life. This can increase the risk
of accumulation and potential toxicity.
A is incorrect; decreased renal blood flow primarily affects drug excretion, not distribution.
B is incorrect; increased gastric pH affects drug absorption rather than distribution.
C is also incorrect; while decreased hepatic mass impacts drug metabolism, it does not directly
affect the distribution of medications.
27. A nurse is reviewing the medical history of a female client who has a new prescription for
phenytoin for seizure activity. Which of the following findings should the nurse report to the
provider?
A. The client has a history of alcohol use disorder.
B. The client uses a diaphragm for contraception.
C. The client is taking allopurinol for gout.
D. The client has a heart rate of 90/min.
Answer: A. The client has a history of alcohol use disorder.
Rationale:
A history of alcohol use disorder is significant because alcohol can interact with phenytoin,
potentially leading to altered metabolism and increased risk of side effects or toxicity. Alcohol
can also affect seizure control, making it crucial for the healthcare provider to be aware of this
history when prescribing phenytoin.
B is not as concerning, as the use of a diaphragm for contraception does not have a direct
interaction with phenytoin.
C is relevant; while allopurinol can increase the risk of a serious skin reaction when used with
phenytoin, the history of alcohol use disorder poses a more immediate concern for the nurse to
report.
D is not significant in this context; a heart rate of 90/min is generally considered normal and
does not require reporting.
28. A nurse is teaching a client who has postherpetic neuralgia and a new prescription for
gabapentin. Which off the following information should the nurse include in the teaching?
A. "You should take this medication on an empty stomach."
B. "You should expect to experience swelling of your lower legs while taking this medication."
C. "You should avoid taking this medication with fruit juice."
D. "You should not take this medication within 2 hours of taking an antacid."
Answer: D. "You should not take this medication within 2 hours of taking an antacid."
Rationale:
Gabapentin can have reduced absorption when taken with antacids containing aluminum or
magnesium. To ensure optimal absorption and effectiveness, it is recommended to space
gabapentin and antacid doses by at least 2 hours.
A is incorrect because gabapentin can be taken with or without food, making it flexible for the
client’s preferences.
B is misleading; while edema can occur in some patients, it is not a common side effect of
gabapentin and should not be expected.
C is incorrect; gabapentin does not have known interactions with fruit juice that would
necessitate avoidance.
29. A nurse is providing discharge teaching to an older adult client who is taking multiple
medications. Which of the following information should the nurse include in the teaching?
A. "You should keep a medication list that includes only your prescribed medications."
B. "You should compare your medication dose with others taking the same medications."
C. "You should not experience adverse effects unless you begin taking a new medication."
D. "You should consult your provider before taking an herbal supplement."
Answer: D. "You should consult your provider before taking an herbal supplement."
Rationale:
Older adults are often prescribed multiple medications, which can increase the risk of drug
interactions. Herbal supplements can interact with prescription medications, potentially altering
their effectiveness or leading to adverse effects. Therefore, it is essential for the client to consult
with their healthcare provider before starting any herbal supplements to ensure safety and
appropriateness.
A is incorrect; the medication list should include all medications, including over-the-counter
drugs and supplements, to provide a complete picture for healthcare providers.
B is not advisable; medication doses can vary based on individual factors, and comparing doses
with others can lead to misinformation and potential harm.
C is misleading; adverse effects can occur with any medication, not just new ones, so the client
should be vigilant about monitoring for side effects throughout their treatment.
30. A nurse is admitting an older adult client who is scheduled for surgery and is completing
medication reconciliation process for which of the following situations?
A. The provider obtains informed consent from the client for surgery.
B. The client returns to the unit from the surgical suite.
C. The pharmacy delivers the client's medications to the unit.
D. The nurse is preparing to provide change-of-shift report.
Answer: B. The client returns to the unit from the surgical suite.
Rationale:
Medication reconciliation is a critical process aimed at ensuring that a patient’s medication list is
accurate and complete, particularly during transitions of care, such as after surgery. When the
client returns from the surgical suite, it is essential to review and reconcile their medications to
account for any changes that may have occurred during surgery, including any medications
administered in the operating room, medications that may have been held, or adjustments to
dosages.
A is incorrect; obtaining informed consent is related to legal and ethical aspects of the surgery,
not medication reconciliation.
C is not relevant to medication reconciliation; the delivery of medications from the pharmacy
does not involve reviewing or reconciling the client's current medications.
D is also incorrect; while providing a change-of-shift report is important, it does not specifically
involve the medication reconciliation process.
31. A nurse is reviewing the medication list of an older adult client and notes the client is taking
simvastatin for hypercholesterolemia as well as multiple herbal supplements. Which of the
following supplements indicated on the client's medication list can decrease this medication?
A. Garlic
B. Ginkgo biloba
C. Glucosamine
D. St. John's wort
Answer: D. St. John's wort
Rationale:
St. John's wort is known to induce certain cytochrome P450 enzymes, particularly CYP3A4,
which is involved in the metabolism of simvastatin. When St. John's wort is taken with
simvastatin, it can decrease the levels of simvastatin in the body, potentially leading to
inadequate control of hypercholesterolemia. This interaction can result in reduced efficacy of
simvastatin, which is important for managing cholesterol levels.
A (Garlic) may have mild cholesterol-lowering effects but does not significantly affect
simvastatin levels.
B (Ginkgo biloba) is known to affect blood clotting but does not have a notable interaction with
simvastatin.
C (Glucosamine) is typically used for joint health and does not impact the metabolism of
simvastatin. Thus, St. John's wort poses the most significant concern regarding decreased
effectiveness of simvastatin.
32. A nurse is reviewing the laboratory results of an older adult client who is taking multiple
medications. Which of the following findings could impact the client's ability to distribute
medication throughout his system?
A. potassium 3.7
B. Total cholesterol 188
C. Hgb 15
E. albumin 3.0
Answer: D. Albumin 3.0 g/dL
Rationale:
Albumin is a protein in the blood that plays a crucial role in drug distribution. Many medications
are protein-bound, meaning they attach to albumin to be transported in the bloodstream. A lower
albumin level can lead to an increased free (unbound) fraction of the drug, which may enhance
the drug's effects and increase the risk of toxicity. An albumin level of 3.0 g/dL is on the lower
end of the normal range and could potentially affect the distribution and effectiveness of
medications in an older adult client.
A (potassium 3.7) is within the normal range and does not directly impact drug distribution.
B (total cholesterol 188) is also within the normal range and is unrelated to medication
distribution.
C (Hgb 15) indicates a normal hemoglobin level and does not affect drug distribution either.
Thus, the albumin level is the most relevant finding impacting medication distribution.
33. A nurse is reviewing the medication list of an older adult client upon admission and notes that
he is taking fluoxetine for depression. The nurse should identify that fluoxetine can increase the
effects of which of the following medications that is also on the client's list?
A. Levothyroxine
B. Gabapentin
C. Warfarin
E. Nadolol
Answer: C. Warfarin
Rationale:
Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) that can inhibit cytochrome P450
enzymes, particularly CYP2C19 and CYP2D6. This inhibition can increase the effects of
warfarin, which is metabolized by these enzymes. As a result, patients taking both fluoxetine and
warfarin may experience an increased risk of bleeding and require careful monitoring of INR
(International Normalized Ratio) levels to ensure safe and effective anticoagulation.
A (Levothyroxine) does not have a significant interaction with fluoxetine.
B (Gabapentin) is not significantly affected by fluoxetine, and while they can be used together,
fluoxetine does not increase gabapentin's effects.
D (Nadolol) is a beta-blocker that does not have a notable interaction with fluoxetine. Therefore,
the interaction between fluoxetine and warfarin is the most clinically significant concern.
