Drug Level Quiz: Therapeutic Or Toxic?

1. A client on methotrexate has a serum level of 0.15 micromoles/L at 48 hours post-dose. Is this level therapeutic?

Yes; level indicates adequate therapy

No; level is too high and indicates toxicity

No; level is subtherapeutic

Cannot determine without peak level

2. True or False: Therapeutic drug levels remain constant regardless of patient age, weight, or renal function.

True

False

3. A client on nortriptyline has a level of 150 ng/mL and reports dry mouth and urinary retention. What is indicated?

Level is therapeutic; side effects are expected

Level is subtherapeutic; increase dose

Level is toxic; reduce dose

Level requires no adjustment

Submit

5. A patient on chloroquine for lupus has a serum level of 1.2 mcg/mL. Is this therapeutic?

Yes; level is in therapeutic range

No; level is subtherapeutic

No; level indicates toxicity

Cannot assess without clinical symptoms

6. Which statement about therapeutic drug level monitoring is accurate?

Levels should be drawn immediately after drug administration

Steady-state is typically reached after 3–5 half-lives

All drugs require routine level monitoring

Renal function does not affect drug levels

7. A client receiving IV procainamide develops hypotension and QT prolongation. The level is 8 mcg/mL. What should the nurse do?

Increase infusion rate for better efficacy

Continue current rate; level is therapeutic

Notify provider; level suggests toxicity

Switch to oral formulation

Submit

9. A patient on phenobarbital has a serum level of 35 mcg/mL and exhibits drowsiness. What is the appropriate action?

Continue dose; level is therapeutic

Increase dose for better seizure control

Reduce dose; level is above therapeutic range

Discontinue immediately

10. Which clinical sign is most indicative of digoxin toxicity?

Increased heart rate

Visual disturbances and arrhythmias

Hyperkalemia

Increased blood pressure

11. A patient on digoxin therapy has a serum level of 2.5 ng/mL. What is the most appropriate nursing action?

Continue current dose; level is therapeutic

Notify provider; level indicates toxicity

Increase dose to reach therapeutic range

Hold dose and recheck in 2 hours

Submit

13. A patient receiving amiodarone develops bradycardia and hypotension. Amiodarone level is 3.5 mcg/mL. What does this suggest?

Subtherapeutic level; increase dose

Therapeutic level; symptoms are expected

Toxic level; discontinue and notify provider

Normal variation; continue current regimen

14. Which factor most significantly affects therapeutic drug levels in elderly patients?

Increased metabolism

Decreased renal and hepatic function

Enhanced drug absorption

Reduced body water content

15. A client on warfarin has an INR of 4.2. What is the most appropriate nursing response?

Continue current dose; INR is therapeutic

Notify provider; INR is above therapeutic range

Increase dose to achieve higher INR

Hold all doses until INR decreases

16. The therapeutic drug level for tobramycin peak is 5–10 mcg/mL. What is the primary reason for peak-and-trough monitoring?

To ensure adequate bactericidal effect and prevent nephrotoxicity

To document compliance with medication schedule

To reduce medication costs

To eliminate the need for renal function tests

17. A patient on lithium therapy presents with coarse tremor, confusion, and ataxia. Which therapeutic drug level range is most concerning?

0.5–1.0 mEq/L

1.0–1.5 mEq/L

Greater than 1.5 mEq/L

Less than 0.5 mEq/L

18. When should vancomycin trough levels be drawn for accurate therapeutic drug level monitoring?

Just before the next dose

30 minutes after infusion completes

Anytime during the dosing interval

At peak level only

19. A client taking theophylline reports tremors and tachycardia. The serum level is 22 mcg/mL. What does this indicate?

Therapeutic level; symptoms are unrelated

Subtherapeutic level; increase dose

Toxic level; reduce dose immediately

Normal response; continue monitoring

20. Which therapeutic drug level range is correct for phenytoin (Dilantin)?

5–15 mcg/mL

10–20 mcg/mL

2–5 mcg/mL

20–30 mcg/mL

Drug Level Quiz: Therapeutic or Toxic?

1. A client on methotrexate has a serum level of 0.15 micromoles/L at 48 hours post-dose. Is this level therapeutic?

2.

What first name or nickname would you like us to use?

2. True or False: Therapeutic drug levels remain constant regardless of patient age, weight, or renal function.

3. A client on nortriptyline has a level of 150 ng/mL and reports dry mouth and urinary retention. What is indicated?

4. The therapeutic drug level for valproic acid is ____ mcg/mL.

5. A patient on chloroquine for lupus has a serum level of 1.2 mcg/mL. Is this therapeutic?

6. Which statement about therapeutic drug level monitoring is accurate?

7. A client receiving IV procainamide develops hypotension and QT prolongation. The level is 8 mcg/mL. What should the nurse do?

8. The therapeutic drug level range for carbamazepine is ____ mcg/mL.

9. A patient on phenobarbital has a serum level of 35 mcg/mL and exhibits drowsiness. What is the appropriate action?

10. Which clinical sign is most indicative of digoxin toxicity?

11. A patient on digoxin therapy has a serum level of 2.5 ng/mL. What is the most appropriate nursing action?

12. The therapeutic drug level for gentamicin trough should be less than ____ mcg/mL to prevent nephrotoxicity.

13. A patient receiving amiodarone develops bradycardia and hypotension. Amiodarone level is 3.5 mcg/mL. What does this suggest?

14. Which factor most significantly affects therapeutic drug levels in elderly patients?

15. A client on warfarin has an INR of 4.2. What is the most appropriate nursing response?

16. The therapeutic drug level for tobramycin peak is 5–10 mcg/mL. What is the primary reason for peak-and-trough monitoring?

17. A patient on lithium therapy presents with coarse tremor, confusion, and ataxia. Which therapeutic drug level range is most concerning?

18. When should vancomycin trough levels be drawn for accurate therapeutic drug level monitoring?

19. A client taking theophylline reports tremors and tachycardia. The serum level is 22 mcg/mL. What does this indicate?

20. Which therapeutic drug level range is correct for phenytoin (Dilantin)?