ATI Custom ASN Pharm NSG 1540 Final Exam Winter
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Free ATI Custom ASN Pharm NSG 1540 Final Exam Winter Questions
Which client statement indicates correct understanding of the medication sucralfate for a newly diagnosed duodenal ulcer?
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"I will take this medication with an antacid to reduce stomach acid."
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"I will chew the tablet thoroughly before swallowing it."
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"I will take this medication with my meals to help digestion."
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"I will take this medication on an empty stomach to coat the ulcer."
Explanation
Sucralfate works by forming a protective barrier over the ulcer site in the stomach and duodenum, shielding it from acid, pepsin, and bile. For maximum effectiveness, it must be taken on an empty stomach — typically 1 hour before meals and at bedtime — so it can adhere directly to the ulcer surface without food interference. Antacids should not be taken within 30 minutes of sucralfate as they reduce its effectiveness. The tablet should be swallowed whole, not chewed. Taking it with meals would reduce its ability to coat the ulcer effectively.
A nurse is administering furosemide to a client who has heart failure and a serum potassium level of 3.0 mEq/L (Normal range 3.5 mEq/L– 5.0 mEq/L). Which action should the nurse take?
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Administer the medication with food to reduce gastrointestinal upset.
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Hold the medication and notify the provider of the potassium level.
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Encourage the client to increase fluid intake before giving the medication.
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Administer the medication as prescribed and recheck potassium after the dose.
Explanation
Correct Answer: B) Hold the medication and notify the provider of the potassium level.
Furosemide is a loop diuretic that causes significant potassium wasting through the kidneys. The client's potassium level of 3.0 mEq/L is already below the normal range of 3.5–5.0 mEq/L, indicating hypokalemia. Administering furosemide in this situation would further deplete potassium levels, placing the client at serious risk for life-threatening cardiac dysrhythmias. The nurse must hold the medication and notify the provider immediately so potassium replacement can be initiated before the diuretic is administered.
A nurse is assessing a client's pain 30 minutes after administering IV morphine for postoperative pain. The client reports adequate pain relief but is now difficult to arouse. The nurse notes a respiratory rate of 8 breaths per minute and shallow respirations. Which action should the nurse take first?
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Encourage the client to take deep breaths.
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Document the client's response to morphine.
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Place the client in a supine position and continue to monitor.
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Administer naloxone (Narcan) per protocol.
Explanation
Correct Answer: D) Administer naloxone (Narcan) per protocol.
The client is exhibiting classic signs of opioid-induced respiratory depression — a respiratory rate of 8 breaths per minute, shallow breathing, and decreased level of consciousness. This is a life-threatening emergency requiring immediate intervention. Naloxone (Narcan) is the opioid antagonist that rapidly reverses opioid toxicity and must be administered first per protocol. Encouraging deep breaths and repositioning are insufficient interventions for this severity of respiratory depression. Documentation is never the priority during an acute emergency and should only occur after the client is stabilized.
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 is teaching a new nurse about safe medication administration. Which action demonstrates that the new nurse understands how to reduce medication errors?
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Preparing medications for multiple clients at the same time to save time.
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Verifying the client's identity with two forms of identification.
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Asking the client to state their diagnosis before giving the medication.
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Delaying documentation until the end of the shift.
Explanation
Correct Answer: B) Verifying the client's identity with two forms of identification.
Using two client identifiers before administering any medication is a fundamental patient safety standard established by The Joint Commission. This typically involves checking the client's name and date of birth or medical record number against the medication administration record. Preparing medications for multiple clients simultaneously increases the risk of mix-ups and errors. Asking for a diagnosis does not confirm client identity. Delaying documentation is unsafe as it increases the risk of duplicate dosing and medication errors, and documentation should occur immediately after administration.
What is the first action a nurse should take when a medication error is identified to ensure the client's safety?
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Reprimand the healthcare team member involved in the error.
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Report the error to the client's family immediately.
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Document the incident in the client's medical record.
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Assess the client's physiological status and monitor for adverse reactions.
Explanation
Correct Answer: D) Assess the client's physiological status and monitor for adverse reactions.
When a medication error is identified, the nurse's first priority is always the client's safety. Immediately assessing the client's physiological status and monitoring for adverse reactions ensures that any harmful effects are identified and treated promptly. Reprimanding a team member is inappropriate and not a safety-focused action. Notifying the family and documenting the incident are important steps but come after the client has been assessed and stabilized. Documentation follows assessment and notification of the provider, not the other way around.
A nurse at an ophthalmology clinic is providing teaching to a client who has been prescribed multiple eye drops. Which of the following instructions about administration of multiple eye drops should the nurse provide?
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Administer the medications 5 min apart.
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It is not necessary to remove contact lenses before administering medications.
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Hold pressure on the conjunctiva sac for 2 min following application of drops.
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Administer the medications by touching the tip of the dropper to the sclera of the eye.
Explanation
Correct Answer: A) Administer the medications 5 min apart.
When multiple eye drops are prescribed, each medication must be administered at least 5 minutes apart to allow adequate absorption and prevent the first drop from being washed out by the second. This ensures each medication achieves its full therapeutic effect. Contact lenses should always be removed before instilling eye drops as they can absorb the medication or cause irritation. Nasolacrimal occlusion (gentle pressure on the inner corner of the eye) rather than the conjunctival sac reduces systemic absorption. The dropper tip must never touch any part of the eye to prevent contamination and infection.
A nurse is caring for a client who has cancer and a new prescription for ondansetron to treat chemotherapy-induced nausea. For which of the following adverse effects should the nurse monitor?
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QT prolongation
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Dependent edema
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Polyuria
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Photosensitivity
Explanation
Ondansetron is a 5-HT3 receptor antagonist antiemetic that carries a known risk of QT prolongation — an abnormal lengthening of the cardiac electrical cycle that can lead to serious ventricular arrhythmias such as Torsades de Pointes. Nurses must monitor the ECG and be cautious when administering ondansetron to clients with pre-existing cardiac conditions or those taking other QT-prolonging medications. Dependent edema, polyuria, and photosensitivity are not recognized adverse effects of ondansetron therapy.
A nurse is teaching a client newly diagnosed with hypothyroidism about the need for thyroid replacement therapy to restore normal thyroid function. Which thyroid medication is the choice for thyroid hormone replacement therapy?
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Propylthiouracil
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Levothyroxine
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Propanolol
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Methimazole
Explanation
Correct Answer: B) Levothyroxine
Levothyroxine is the standard first-line medication for thyroid hormone replacement therapy in hypothyroidism. It is a synthetic form of thyroxine (T4) that replaces the deficient hormone and restores normal metabolic function. Propylthiouracil and methimazole are antithyroid medications used to treat hyperthyroidism by suppressing thyroid hormone production — they are the opposite of what a hypothyroid client needs. Propranolol is a beta-blocker sometimes used to manage symptoms of hyperthyroidism such as tachycardia and tremors, but it does not replace thyroid hormone.
A client is receiving opioid therapy for pain control. The nurse explains that developing tolerance to the drug means which of the following?
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The drug is no longer working.
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Higher doses may be required for the same effect.
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The client is becoming addicted.
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The client will have withdrawal symptoms.
Explanation
Correct Answer: B) Higher doses may be required for the same effect.
Drug tolerance is a pharmacological phenomenon where the body adapts to a medication over time, resulting in a diminished response to the same dose. This means progressively higher doses may be needed to achieve the same level of pain relief. Tolerance does not mean the drug has stopped working entirely, nor does it indicate addiction, which involves psychological dependence and drug-seeking behavior. Withdrawal symptoms occur with physical dependence when the drug is abruptly stopped, which is a separate concept from tolerance.
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