ATI Custom ASN Pharm NSG 1540 Final Exam Winter
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Free ATI Custom ASN Pharm NSG 1540 Final Exam Winter Questions
A nurse is caring for a client admitted with diabetic ketoacidosis (DKA) who requires continuous IV insulin therapy. As the nurse prepares the medication, which type of insulin should be selected for the continuous IV infusion?
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Glargine
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Regular insulin
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Humalog
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NPH
Explanation
Correct Answer: B) Regular insulin
Regular insulin is the only type of insulin approved and safe for intravenous administration. It has a rapid onset when given IV and can be precisely titrated through continuous infusion to manage the severe hyperglycemia and metabolic acidosis seen in DKA. Glargine and NPH are long-acting insulins that are only administered subcutaneously and are never given IV. Humalog (lispro) is a rapid-acting analog used subcutaneously and is not approved for continuous IV infusion in DKA management.
A nurse is caring for a client who is experiencing nausea and has a prescription for metoclopramide. The client asks the nurse how this medication will help their symptoms. Which of the following responses should the nurse provide?
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"It numbs the lining of your stomach so you don't feel nauseated."
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"It works by decreasing the acid in your stomach to prevent irritation."
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"It coats your stomach to protect it from foods that may cause nausea."
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"It helps reduce your nausea by improving how quickly your stomach empties."
Explanation
Metoclopramide is a prokinetic agent that works by blocking dopamine receptors in the chemoreceptor trigger zone and enhancing gastric motility, accelerating gastric emptying. This reduces nausea and vomiting by moving stomach contents into the small intestine more quickly, preventing the buildup that triggers nausea. It does not numb the stomach lining, reduce acid production, or coat the stomach — those mechanisms belong to local anesthetics, antacids/PPIs, and sucralfate respectively.
A nurse administers 10 mg of oral hydrocodone/acetaminophen to a client who reports postoperative pain rated 7/10. After giving the medication, the client asks, "When should I expect this to start helping my pain?" What is the most appropriate response from the nurse?
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"It will take about 2 to 3 hours before you feel any change."
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"You should feel relief within about 5 to 10 minutes."
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"You should feel the full effect in less than 5 minutes."
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"You should start noticing effects in about 60 minutes."
Explanation
Correct Answer: D) "You should start noticing effects in about 60 minutes."
Oral hydrocodone/acetaminophen has an onset of action of approximately 30 to 60 minutes when taken by mouth, as it must first be absorbed through the gastrointestinal tract before entering the bloodstream. Telling the client effects will begin in about 60 minutes sets realistic expectations and promotes medication understanding. Onset of 2 to 3 hours is too long and inaccurate for this medication. Effects within 5 to 10 minutes or less than 5 minutes are characteristic of IV opioid administration, not oral, and would be misleading and incorrect.
A nurse is caring for a client who is experiencing acute supraventricular tachycardia due to an irregular heart rhythm. Which medication should the nurse prepare to administer?
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adenosine (Adenocard)
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metoprolol (Lopressor)
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warfarin (Coumadin)
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carvedilol (Coreg)
Explanation
Correct Answer: A) adenosine (Adenocard)
Adenosine is the first-line drug of choice for acute supraventricular tachycardia (SVT). It works by briefly blocking conduction through the AV node, interrupting the reentry circuit responsible for SVT and restoring normal sinus rhythm. It acts within seconds and is administered as a rapid IV push. Metoprolol and carvedilol are beta-blockers used for rate control in chronic conditions but are not first-line for acute SVT conversion. Warfarin is an anticoagulant used to prevent clot formation and has no role in acute rhythm conversion.
A nurse administers sublingual nitroglycerin for chest pain. Which client manifestation requires immediate action?
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Dizziness when standing
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Mild headache
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Dry mouth
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Blood pressure of 86/58 mmHg
Explanation
Nitroglycerin is a vasodilator that dilates blood vessels to relieve chest pain by reducing cardiac workload. Its most dangerous adverse effect is severe hypotension. A blood pressure of 86/58 mmHg indicates significant hypotension requiring immediate intervention, as it can lead to syncope, organ hypoperfusion, and cardiovascular collapse. Dizziness when standing and mild headache are common, expected side effects of nitroglycerin due to vasodilation. Dry mouth is not a primary concern with nitroglycerin administration.
What should the nurse consider when administering medication to a client who is an older adult?
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Assuming all drugs are equally absorbed regardless of age.
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Monitoring for adverse effects due to polypharmacy.
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Administering higher doses due to increased renal function.
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Ignoring Beers Criteria when selecting medications.
Explanation
Correct Answer: B) Monitoring for adverse effects due to polypharmacy.
Older adults are at significantly higher risk for polypharmacy — the concurrent use of multiple medications — which increases the likelihood of drug interactions and adverse effects. Age-related physiological changes such as decreased renal and hepatic function, reduced body water, and altered drug metabolism mean that older adults require lower doses, not higher ones. Drug absorption, distribution, and elimination are all affected by aging. The Beers Criteria is an essential tool specifically designed to identify potentially inappropriate medications for older adults and should never be ignored.
A nurse is monitoring a client who has been prescribed warfarin. Which manifestation should the nurse report as a possible adverse effect of the medication?
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Constipation
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Bleeding gums
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Increased appetite
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Dry mouth
Explanation
Correct Answer: B) Bleeding gums
Warfarin is an anticoagulant that works by inhibiting Vitamin K-dependent clotting factors, thereby preventing blood clot formation. Its most serious and significant adverse effect is bleeding, which can manifest in various ways including bleeding gums, unusual bruising, blood in urine or stool, or prolonged bleeding from cuts. Bleeding gums are a classic early sign of warfarin toxicity and must be reported immediately. Constipation, increased appetite, and dry mouth are not associated with warfarin therapy and are not expected adverse effects of anticoagulation.
A nurse is reinforcing teaching with a client who is starting therapy with acid-controlling medications. Which of the following statements by the client indicate understanding of the teaching? (Select All that Apply.)
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"I will take omeprazole before eating in the morning."
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"I will report black, tarry stools to my provider."
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"I should chew enteric-coated tablets for faster relief."
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"I should avoid taking antacids at the same time as other medications."
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"I can stop taking ranitidine once I feel better."
Explanation
Correct Answers: A) "I will take omeprazole before eating in the morning," B) "I will report black, tarry stools to my provider," and D) "I should avoid taking antacids at the same time as other medications."
Omeprazole, a proton pump inhibitor, should be taken 30–60 minutes before eating to maximize its effectiveness in reducing gastric acid secretion. Black, tarry stools indicate GI bleeding and must always be reported immediately to the provider. Antacids can interfere with the absorption of many medications and should not be taken simultaneously with other drugs. Enteric-coated tablets must never be chewed as the coating protects the medication from stomach acid and ensures proper absorption in the intestine. Acid-controlling medications should be taken for the full prescribed duration even if symptoms improve, as stopping early can lead to relapse.
A nurse is evaluating the effectiveness of carbidopa-levodopa in a client who has Parkinson's Disease. Which manifestation should indicate the medication is effective?
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Improved motor function
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Decreased heart rate
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Improved visual acuity
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Increased blood pressure
Explanation
Correct Answer: A) Improved motor function
Carbidopa-levodopa is the primary treatment for Parkinson's Disease. It works by replenishing dopamine in the brain, which directly improves motor symptoms such as tremors, rigidity, bradykinesia, and postural instability. Improved motor function is therefore the expected therapeutic outcome indicating the medication is working. Decreased heart rate, improved visual acuity, and increased blood pressure are not therapeutic goals of carbidopa-levodopa and do not reflect its effectiveness in managing Parkinson's Disease.
A nurse is caring for a client taking atorvastatin. Why is it important for the client to take this medication at night?
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To promote sleep
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Improved urinary output
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Blood pressure will be lowered
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Cholesterol production peaks at night
Explanation
Correct Answer: D) Cholesterol production peaks at night
Atorvastatin belongs to the statin class of medications that work by inhibiting HMG-CoA reductase, the enzyme responsible for cholesterol synthesis in the liver. The liver produces the majority of cholesterol at night during fasting, making evening administration the most pharmacologically effective time to take the medication. Taking it at night ensures peak drug levels coincide with peak cholesterol production, maximizing its therapeutic effect. It has no significant effect on sleep, urinary output, or blood pressure.
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