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 who has been prescribed lithium for bipolar disorder and is assessing the client for potential adverse effects of the medication. Which assessment should the nurse prioritize to monitor for early signs of lithium toxicity?
- Monitor for nasal congestion and sinus pressure.
- Assess for increased appetite and weight gain.
- Monitor for decreased visual acuity.
- Assess for new-onset tremors or muscle twitching.
Explanation
Correct Answer: D) Assess for new-onset tremors or muscle twitching.
Lithium has a very narrow therapeutic index, making toxicity monitoring critical. Early signs of lithium toxicity include fine hand tremors, muscle twitching, nausea, vomiting, diarrhea, and drowsiness. As toxicity progresses, coarse tremors, confusion, seizures, and cardiac dysrhythmias can develop. New-onset tremors or muscle twitching are among the earliest and most important warning signs to assess. Nasal congestion, increased appetite, and decreased visual acuity are not hallmark indicators of lithium toxicity.
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?
-
Glargine
-
Regular insulin
-
Humalog
-
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 preparing to mix regular insulin and NPH insulin in the same syringe for a client with diabetes. Which action by the nurse is correct regarding mixing insulin?
- Warming the mixed insulin syringe in hot water before administration.
- Storing the mixed insulin syringe upright for several hours before administration.
- Gently rolling the syringe between the palms to mix the insulin.
- Shaking the syringe vigorously to mix the insulin quickly.
Explanation
Correct Answer: C) Gently rolling the syringe between the palms to mix the insulin.
When mixing insulins, the syringe should be gently rolled between the palms to ensure even mixing without damaging the insulin molecules or creating air bubbles. The correct technique when drawing up mixed insulins is to draw regular (clear) insulin first, followed by NPH (cloudy) insulin. Warming insulin in hot water can degrade the medication. Storing a mixed syringe upright for several hours is incorrect as mixed insulins should be administered promptly. Shaking the syringe vigorously causes air bubbles, alters dosing accuracy, and can denature the insulin.
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?
- "It numbs the lining of your stomach so you don't feel nauseated."
- "It works by decreasing the acid in your stomach to prevent irritation."
- "It coats your stomach to protect it from foods that may cause nausea."
- "It helps reduce your nausea by improving how quickly your stomach empties."
Explanation
Correct Answer: D) "It helps reduce your nausea by improving how quickly your stomach empties."
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 is caring for a client who is receiving a continuous heparin infusion and has developed thrombocytopenia. Which is the most important concern for the nurse?
- Bleeding
- Hypertension
- Infection
- Bradycardia
Explanation
Correct Answer: A) Bleeding
When a client on heparin develops thrombocytopenia — a significant drop in platelet count — the nurse's greatest concern is bleeding. This condition is known as Heparin-Induced Thrombocytopenia (HIT), where the immune system destroys platelets, paradoxically increasing clotting risk while simultaneously reducing the platelet count available to stop bleeding. With fewer platelets and an anticoagulant already on board, the client is at extreme risk for uncontrolled bleeding. Hypertension, infection, and bradycardia are not the primary concerns associated with HIT or heparin-induced thrombocytopenia.
What should the nurse consider when administering medication to a client who is an older adult?
- Assuming all drugs are equally absorbed regardless of age.
- Monitoring for adverse effects due to polypharmacy.
- Administering higher doses due to increased renal function.
- 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 teaching a client who has type 1 diabetes mellitus how to self-administer subcutaneous insulin. Which instruction should the nurse include to promote safe and effective administration?
- Aspirate before injecting to ensure the needle is not in a blood vessel.
- Store the insulin pen in the refrigerator after opening and between uses to maintain potency.
- Pinch the skin and insert the needle at a 45- to 90-degree angle.
- Massage the injection site for 1 minute after administering the insulin.
Explanation
Correct Answer: C) Pinch the skin and insert the needle at a 45- to 90-degree angle.
For subcutaneous insulin injection, the client should pinch the skin to lift the subcutaneous tissue away from the muscle and insert the needle at a 45- to 90-degree angle depending on the client's body size and needle length. This ensures the insulin is deposited into the subcutaneous layer for proper absorption. Aspiration is no longer recommended for subcutaneous injections as subcutaneous sites have minimal vascular risk. Insulin pens in use are stored at room temperature, not refrigerated. Massaging the injection site after administration is avoided as it can cause erratic, unpredictable insulin absorption.
A nurse is preparing to administer spironolactone to a client who has hypertension and a serum potassium level of 3.5 mEq/L (normal: 3.5–5.0 mEq/L). Which action should the nurse take?
- Withhold the spironolactone and notify the provider.
- Administer the spironolactone as prescribed.
- Administer a potassium supplement along with spironolactone.
- Increase the dose of spironolactone.
Explanation
Correct Answer: B) Administer the spironolactone as prescribed.
Spironolactone is a potassium-sparing diuretic, meaning it retains potassium rather than excreting it. The client's potassium level of 3.5 mEq/L falls exactly at the lower limit of the normal range (3.5–5.0 mEq/L), which is acceptable for administration. There is no indication to withhold the medication, as the level is not below normal. Administering a potassium supplement alongside spironolactone would risk hyperkalemia, as the drug already conserves potassium. Increasing the dose is not indicated based on the potassium level alone and requires a provider order.
15 mg ÷ 5 mg × 5 mL = 15 mL per dose
A nurse is preparing to administer a prescribed medication to a client who is experiencing severe nausea and vomiting. Which route of administration used by the nurse is an example of a parenteral medication route?
- Oral tablet
- Rectal suppository
- Intravenous
- Otic drops
Explanation
Correct Answer: C) Intravenous
Parenteral routes of administration refer to any route that bypasses the gastrointestinal tract, and most commonly refers to injectable routes including intravenous (IV), intramuscular (IM), and subcutaneous (SQ). The IV route is the ideal choice for a client with severe nausea and vomiting since oral administration would be ineffective. Oral tablets and rectal suppositories are enteral routes as they involve the GI tract. Otic drops are a topical local route, not parenteral.
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