ATI Custom NUR3025 Pharmacology Exam Two_V5
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Free ATI Custom NUR3025 Pharmacology Exam Two_V5 Questions
1. A patient has received an overdose of intravenous heparin and is showing signs of excessive bleeding. Which substance is the antidote for heparin overdose?
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Vitamin K
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Vitamin E
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Potassium Chloride
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Protamine Sulfate
Explanation
Explanation
Protamine sulfate is the specific antidote for heparin overdose. It is a positively charged protein that binds directly to heparin — a negatively charged molecule — forming a stable, inactive complex that neutralizes heparin's anticoagulant effect. It is administered intravenously and works rapidly to reverse excessive anticoagulation and control bleeding.
Why the other options are incorrect:
A. Vitamin K — Vitamin K is the antidote for warfarin overdose, not heparin. It works by replenishing the vitamin K-dependent clotting factors that warfarin inhibits, which is a completely different mechanism from heparin's action.
B. Vitamin E — Vitamin E has mild anticoagulant properties at high doses and has no role as an antidote for heparin toxicity.
C. Potassium Chloride — Potassium chloride is used to treat hypokalemia and has no antidotal properties against heparin. Administering it in this context would be inappropriate and potentially dangerous.
Protamine sulfate is the specific antidote for heparin overdose. It is a positively charged protein that binds directly to heparin — a negatively charged molecule — forming a stable, inactive complex that neutralizes heparin's anticoagulant effect. It is administered intravenously and works rapidly to reverse excessive anticoagulation and control bleeding.
Why the other options are incorrect:
A. Vitamin K — Vitamin K is the antidote for warfarin overdose, not heparin. It works by replenishing the vitamin K-dependent clotting factors that warfarin inhibits, which is a completely different mechanism from heparin's action.
B. Vitamin E — Vitamin E has mild anticoagulant properties at high doses and has no role as an antidote for heparin toxicity.
C. Potassium Chloride — Potassium chloride is used to treat hypokalemia and has no antidotal properties against heparin. Administering it in this context would be inappropriate and potentially dangerous.
2. A nurse is caring for a patient receiving a highly protein-bound medication. The patient's albumin levels are found to be significantly decreased. How should the nurse interpret this finding regarding the drug's pharmacologic effect?
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There will be no change in drug effect as binding does not influence drug activity.
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The pharmacologic effect may be increased because more unbound drug is available to act on receptors.
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The drug will be entirely inactive until albumin levels return to normal.
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The pharmacologic effect will be decreased because less drug is available to bind receptors.
Explanation
Explanation
Correct Answer: (B) The pharmacologic effect may be increased because more unbound drug is available to act on receptors.
Only unbound (free) drug is pharmacologically active. When albumin levels are low, less drug binds to protein, leaving more free drug available to act on receptors, which increases the drug's pharmacologic effect and potential for toxicity.
Why the other options are incorrect:
A. Protein binding significantly influences drug activity by determining how much free drug is available; this statement is incorrect.
C. The drug does not become entirely inactive with low albumin. In fact, the opposite occurs — more drug remains active due to reduced binding.
D. Decreased albumin reduces protein binding, which increases rather than decreases the amount of free drug available to act on receptors.
Correct Answer: (B) The pharmacologic effect may be increased because more unbound drug is available to act on receptors.
Only unbound (free) drug is pharmacologically active. When albumin levels are low, less drug binds to protein, leaving more free drug available to act on receptors, which increases the drug's pharmacologic effect and potential for toxicity.
Why the other options are incorrect:
A. Protein binding significantly influences drug activity by determining how much free drug is available; this statement is incorrect.
C. The drug does not become entirely inactive with low albumin. In fact, the opposite occurs — more drug remains active due to reduced binding.
D. Decreased albumin reduces protein binding, which increases rather than decreases the amount of free drug available to act on receptors.
3. The physician ordered 500 mL of 5% D 0.45 normal saline solution to be infused over 2 hours. If the tubing delivers 10 gtt/mL, how many gtts per minute should be given?
Explanation
Explanation
Using the IV flow rate formula: Flow rate (gtts/min) = Volume (mL) × Drop factor (gtt/mL) ÷ Time (minutes) = 500 mL × 10 gtt/mL ÷ 120 minutes = 5000 ÷ 120 = 41.67 ≈ 42 gtts/min
Using the IV flow rate formula: Flow rate (gtts/min) = Volume (mL) × Drop factor (gtt/mL) ÷ Time (minutes) = 500 mL × 10 gtt/mL ÷ 120 minutes = 5000 ÷ 120 = 41.67 ≈ 42 gtts/min
4. Which type of insulin has a duration of action lasting 24 hours after administration?
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Detemir
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Glargine
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Humulin R
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Lispro
Explanation
Explanation
Insulin glargine (Lantus) is a long-acting basal insulin with a relatively peakless, steady absorption profile and a duration of action of approximately 24 hours. It is administered once daily to provide consistent background insulin coverage throughout the day and night, making it ideal for basal glycemic control in both type 1 and type 2 diabetes.
Why the other options are incorrect:
A. Detemir — Insulin detemir is also a long-acting insulin but has a duration of action of approximately 18 to 23 hours, which is shorter and more variable than glargine. It is often dosed twice daily for consistent coverage.
C. Humulin R — Humulin R is a short-acting (regular) insulin with an onset of 30 to 60 minutes and a duration of approximately 6 to 10 hours. It is used for mealtime coverage, not basal control.
D. Lispro — Insulin lispro is a rapid-acting insulin with an onset of 15 minutes and a duration of only 3 to 5 hours. It is used immediately before meals to manage postprandial glucose spikes.
Insulin glargine (Lantus) is a long-acting basal insulin with a relatively peakless, steady absorption profile and a duration of action of approximately 24 hours. It is administered once daily to provide consistent background insulin coverage throughout the day and night, making it ideal for basal glycemic control in both type 1 and type 2 diabetes.
Why the other options are incorrect:
A. Detemir — Insulin detemir is also a long-acting insulin but has a duration of action of approximately 18 to 23 hours, which is shorter and more variable than glargine. It is often dosed twice daily for consistent coverage.
C. Humulin R — Humulin R is a short-acting (regular) insulin with an onset of 30 to 60 minutes and a duration of approximately 6 to 10 hours. It is used for mealtime coverage, not basal control.
D. Lispro — Insulin lispro is a rapid-acting insulin with an onset of 15 minutes and a duration of only 3 to 5 hours. It is used immediately before meals to manage postprandial glucose spikes.
5. A nurse is caring for a patient who has been using the nasal decongestant phenylephrine for the past 10 days for sinusitis. The nurse should assess the patient for which adverse effect of the medication.
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Constipation
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Productive cough
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Sedation
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Nasal congestion
Explanation
Explanation
Correct Answer: (D) Nasal congestion.
Prolonged use of topical nasal decongestants like phenylephrine beyond the recommended 3 to 5 days can cause rebound nasal congestion, known as rhinitis medicamentosa. This occurs because the nasal mucosa becomes dependent on the medication, and congestion worsens when it wears off, creating a cycle of overuse. After 10 days of use, this is the primary adverse effect the nurse should assess for.
Why the other options are incorrect:
A. Constipation — Constipation is not a recognized adverse effect of phenylephrine nasal decongestants when used topically.
B. Productive cough — Phenylephrine does not cause productive cough. This is more commonly associated with ACE inhibitors or respiratory conditions.
C. Sedation — Phenylephrine is a sympathomimetic agent that causes stimulation, not sedation. Sedation is more associated with first-generation antihistamines.
Correct Answer: (D) Nasal congestion.
Prolonged use of topical nasal decongestants like phenylephrine beyond the recommended 3 to 5 days can cause rebound nasal congestion, known as rhinitis medicamentosa. This occurs because the nasal mucosa becomes dependent on the medication, and congestion worsens when it wears off, creating a cycle of overuse. After 10 days of use, this is the primary adverse effect the nurse should assess for.
Why the other options are incorrect:
A. Constipation — Constipation is not a recognized adverse effect of phenylephrine nasal decongestants when used topically.
B. Productive cough — Phenylephrine does not cause productive cough. This is more commonly associated with ACE inhibitors or respiratory conditions.
C. Sedation — Phenylephrine is a sympathomimetic agent that causes stimulation, not sedation. Sedation is more associated with first-generation antihistamines.
6. Several patients have standard orders for acetaminophen as needed for pain. While reviewing their histories and assessments, the nurse discovers that one of the patients has a contraindication to acetaminophen. Which patient should not receive acetaminophen?
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A patient with a fever of 103.4°F (39.7°C)
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A patient who had abdominal surgery yesterday
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A patient admitted with severe hepatitis
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A patient admitted with deep vein thrombosis
Explanation
Explanation
Correct Answer: (C) A patient admitted with severe hepatitis.
Acetaminophen is metabolized by the liver, and in patients with severe hepatic disease such as hepatitis, the liver's ability to safely process the drug is significantly impaired. This increases the risk of hepatotoxicity and acute liver failure. Severe liver disease is a primary contraindication to acetaminophen use.
Why Other Options are Incorrect:
A. A patient with a fever — Fever is actually one of the indications for acetaminophen use, as it is an effective antipyretic. This patient would benefit from the medication.
B. A patient who had abdominal surgery yesterday — Post-surgical pain management is an appropriate indication for acetaminophen. Recent abdominal surgery alone is not a contraindication.
D. A patient with deep vein thrombosis — DVT does not contraindicate acetaminophen use. Unlike NSAIDs, acetaminophen does not significantly affect platelet function or anticoagulation, making it generally safe in this population.
Correct Answer: (C) A patient admitted with severe hepatitis.
Acetaminophen is metabolized by the liver, and in patients with severe hepatic disease such as hepatitis, the liver's ability to safely process the drug is significantly impaired. This increases the risk of hepatotoxicity and acute liver failure. Severe liver disease is a primary contraindication to acetaminophen use.
Why Other Options are Incorrect:
A. A patient with a fever — Fever is actually one of the indications for acetaminophen use, as it is an effective antipyretic. This patient would benefit from the medication.
B. A patient who had abdominal surgery yesterday — Post-surgical pain management is an appropriate indication for acetaminophen. Recent abdominal surgery alone is not a contraindication.
D. A patient with deep vein thrombosis — DVT does not contraindicate acetaminophen use. Unlike NSAIDs, acetaminophen does not significantly affect platelet function or anticoagulation, making it generally safe in this population.
7. The nurse is administering medications to the patient who is in renal failure resulting from end-stage renal disease. The nurse is aware that patients with kidney failure would most likely have problems with which pharmacokinetic process?
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Distribution
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Metabolism
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Excretion
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Absorption
Explanation
Explanation
Correct Answer: (C) Excretion.
The kidneys are the primary organs responsible for excreting medications and their metabolites from the body. In end-stage renal disease, severely impaired kidney function leads to reduced drug clearance, causing medications to accumulate in the body to potentially toxic levels. Dosage adjustments are essential in patients with renal failure to prevent toxicity.
Why Other Options are Incorrect:
A. Distribution — Distribution refers to how a drug moves through body compartments and is primarily affected by protein binding, tissue perfusion, and body composition, not renal function.
B. Metabolism — Drug metabolism occurs primarily in the liver, not the kidneys. While renal failure can have some secondary effects, the liver remains the primary site of drug metabolism.
D. Absorption — Absorption occurs in the gastrointestinal tract and is not significantly affected by kidney failure unless the patient has severe uremic gastroparesis, which is a secondary complication rather than a primary pharmacokinetic concern.
Correct Answer: (C) Excretion.
The kidneys are the primary organs responsible for excreting medications and their metabolites from the body. In end-stage renal disease, severely impaired kidney function leads to reduced drug clearance, causing medications to accumulate in the body to potentially toxic levels. Dosage adjustments are essential in patients with renal failure to prevent toxicity.
Why Other Options are Incorrect:
A. Distribution — Distribution refers to how a drug moves through body compartments and is primarily affected by protein binding, tissue perfusion, and body composition, not renal function.
B. Metabolism — Drug metabolism occurs primarily in the liver, not the kidneys. While renal failure can have some secondary effects, the liver remains the primary site of drug metabolism.
D. Absorption — Absorption occurs in the gastrointestinal tract and is not significantly affected by kidney failure unless the patient has severe uremic gastroparesis, which is a secondary complication rather than a primary pharmacokinetic concern.
8. The patient had the following: 1½ cups of coffee, 10 oz of water, 8 oz of juice. What is the total intake in mL for this patient?
Explanation
Explanation
Correct Answer: 690 mL
Using standard conversions (1 cup = 240 mL, 1 oz = 30 mL): 1½ cups of coffee = 1.5 × 240 = 360 mL 10 oz of water = 10 × 30 = 300 mL 8 oz of juice = 8 × 30 = 240 mL Total = 360 + 300 + 240 = 900 mL
Note: If the problem uses 1 cup = 8 oz = 240 mL, then 1½ cups = 360 mL. However, some institutions use 1 cup = 6 oz = 180 mL for coffee cups, which would give 1½ cups = 270 mL, resulting in 270 + 300 + 240 = 810 mL. The most standard calculation using 240 mL per cup yields 900 mL.
Correct Answer: 690 mL
Using standard conversions (1 cup = 240 mL, 1 oz = 30 mL): 1½ cups of coffee = 1.5 × 240 = 360 mL 10 oz of water = 10 × 30 = 300 mL 8 oz of juice = 8 × 30 = 240 mL Total = 360 + 300 + 240 = 900 mL
Note: If the problem uses 1 cup = 8 oz = 240 mL, then 1½ cups = 360 mL. However, some institutions use 1 cup = 6 oz = 180 mL for coffee cups, which would give 1½ cups = 270 mL, resulting in 270 + 300 + 240 = 810 mL. The most standard calculation using 240 mL per cup yields 900 mL.
9. A nurse is administering timolol eye drops to a client who has glaucoma. Which of the following actions should the nurse take?
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Protect the distal portion of the eyedropper using clean technique.
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Drop prescribed amount of medication into the conjunctival sac.
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Wipe the eye from the outer canthus to the inner canthus before instillation.
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Apply pressure to the bridge of the nose after administration.
Explanation
Explanation
Applying gentle pressure to the nasolacrimal duct (inner canthus/bridge of the nose) for 1 to 2 minutes after instillation prevents systemic absorption of timolol through the nasolacrimal drainage system. This is especially critical with timolol, a beta-blocker, because systemic absorption can cause bradycardia, bronchospasm, and hypotension — particularly dangerous in patients with cardiac or pulmonary conditions.
Why the other options are incorrect:
A. Protect the distal portion of the eyedropper using clean technique — The tip of the eyedropper must be kept sterile, not just clean. Contamination of the dropper tip can introduce pathogens directly into the eye, causing serious infection.
B. Drop medication into the conjunctival sac — While this is correct technique for eye drop administration, it is not the most critical safety-focused action specific to timolol. Nasolacrimal occlusion after instillation is the more important distinguishing action.
C. Wipe from outer canthus to inner canthus before instillation — Correct technique for wiping the eye is from the inner canthus to the outer canthus to avoid introducing debris toward the tear duct. Wiping from outer to inner is incorrect technique.
Applying gentle pressure to the nasolacrimal duct (inner canthus/bridge of the nose) for 1 to 2 minutes after instillation prevents systemic absorption of timolol through the nasolacrimal drainage system. This is especially critical with timolol, a beta-blocker, because systemic absorption can cause bradycardia, bronchospasm, and hypotension — particularly dangerous in patients with cardiac or pulmonary conditions.
Why the other options are incorrect:
A. Protect the distal portion of the eyedropper using clean technique — The tip of the eyedropper must be kept sterile, not just clean. Contamination of the dropper tip can introduce pathogens directly into the eye, causing serious infection.
B. Drop medication into the conjunctival sac — While this is correct technique for eye drop administration, it is not the most critical safety-focused action specific to timolol. Nasolacrimal occlusion after instillation is the more important distinguishing action.
C. Wipe from outer canthus to inner canthus before instillation — Correct technique for wiping the eye is from the inner canthus to the outer canthus to avoid introducing debris toward the tear duct. Wiping from outer to inner is incorrect technique.
10. A corticosteroid, prednisone, is prescribed for a client with diabetes mellitus who is using Humulin 70/30 daily. Which of the following prescription changes does the nurse expect during the therapy with the prednisone?
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Decreased dosage of Humulin 70/30
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Add an oral hypoglycemic medication.
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Increased dosage of prednisone.
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Increased dosage of Humulin 70/30.
Explanation
Explanation
Corticosteroids such as prednisone cause significant hyperglycemia by stimulating gluconeogenesis, reducing insulin sensitivity, and impairing glucose uptake in cells. In a diabetic patient already using insulin, prednisone will raise blood glucose levels substantially, requiring an increase in the insulin dosage to maintain glycemic control throughout the course of corticosteroid therapy.
Why the other options are incorrect:
A. Decreased dosage of Humulin 70/30 — Decreasing insulin during corticosteroid therapy would be dangerous and counterproductive, as prednisone raises blood glucose and more insulin is needed, not less.
B. Add an oral hypoglycemic medication — While oral agents may be used in some situations, for a patient already on insulin therapy, the most direct and effective adjustment is to increase the insulin dose rather than adding an oral agent.
C. Increased dosage of prednisone — The prednisone dose is determined by the underlying condition being treated, not by the patient's diabetic status or insulin requirements.
Corticosteroids such as prednisone cause significant hyperglycemia by stimulating gluconeogenesis, reducing insulin sensitivity, and impairing glucose uptake in cells. In a diabetic patient already using insulin, prednisone will raise blood glucose levels substantially, requiring an increase in the insulin dosage to maintain glycemic control throughout the course of corticosteroid therapy.
Why the other options are incorrect:
A. Decreased dosage of Humulin 70/30 — Decreasing insulin during corticosteroid therapy would be dangerous and counterproductive, as prednisone raises blood glucose and more insulin is needed, not less.
B. Add an oral hypoglycemic medication — While oral agents may be used in some situations, for a patient already on insulin therapy, the most direct and effective adjustment is to increase the insulin dose rather than adding an oral agent.
C. Increased dosage of prednisone — The prednisone dose is determined by the underlying condition being treated, not by the patient's diabetic status or insulin requirements.
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