ATI Pharmacology Exam

Correct Answer:

Carry a supply of pills and a single-use injectable preparation with you at all times

Explanation:

This is the correct answer. Clients with primary adrenal insufficiency (Addison’s disease) have insufficient production of glucocorticoids, like cortisol, which are essential for the body’s response to stress, metabolism, and inflammation. During periods of illness, injury, or stress, the body typically increases cortisol production. Therefore, it is critical for these individuals to always carry both a supply of oral hydrocortisone and an injectable form, such as hydrocortisone sodium succinate. This ensures they can quickly replace glucocorticoids during an emergency, such as an adrenal crisis, when they are unable to take oral medications. This preparation is essential to manage life-threatening situations.

Why Other Options Are Wrong:

You may need to take a lower dosage when you are ill or experiencing stress

This is incorrect. When a client with Addison's disease is ill, stressed, or undergoing surgery, they typically need an increased dosage of hydrocortisone to mimic the body's natural increase in cortisol production during stress. Reducing the dosage in such situations would put the client at significant risk for adrenal crisis.

Take this medication before going to bed because it will make you tired

This is incorrect. Hydrocortisone should be taken in the morning, as it is meant to mimic the body’s natural cortisol production, which peaks in the morning and decreases throughout the day. Taking it at night can interfere with sleep and disrupt the natural circadian rhythm of cortisol release.

You will need to stop this medication before routine procedures such as a colonoscopy

This is incorrect. Clients with Addison's disease should not stop taking hydrocortisone before procedures. In fact, they may require higher doses of hydrocortisone during such procedures to help manage stress. Abrupt discontinuation of hydrocortisone can lead to an adrenal crisis, which can be life-threatening.

Correct Answer C. Dual-energy x-ray absorptiometry (Dexa scan)

Explanation of Correct Answer:

C. Dual-energy x-ray absorptiometry (Dexa scan)

The effectiveness of alendronate, a medication used to treat osteoporosis, is typically evaluated by monitoring changes in bone mineral density (BMD). The Dual-energy x-ray absorptiometry (Dexa scan) is the gold standard for assessing BMD and evaluating the progression or improvement of osteoporosis. The nurse should review the results of a recent Dexa scan to determine how well the treatment with alendronate is working.

Why the Other Options Are Incorrect:

A. Hemoglobin A1C (Hb A1C)

This is incorrect because the Hemoglobin A1C test is used to monitor long-term blood glucose control in patients with diabetes, not osteoporosis. It is not relevant for evaluating the effectiveness of alendronate.

B. Urine specific gravity

This is incorrect because urine specific gravity is a measure of urine concentration, typically used to assess kidney function or hydration status. It is not used to monitor bone density or the effectiveness of osteoporosis treatment.

D. Lumbar puncture

This is incorrect because a lumbar puncture is a procedure used to obtain cerebrospinal fluid for diagnosing conditions related to the central nervous system, such as infections or neurological disorders. It is not relevant to evaluating the effectiveness of alendronate in treating osteoporosis.

Correct Answer:

Decreased platelet aggregation

Explanation:

This is the correct answer. Ginkgo biloba, an herbal supplement, is known to inhibit platelet-activating factor, which leads to decreased platelet aggregation. This action can make blood flow smoother, but it also increases the risk of bleeding, especially when combined with anticoagulants (like warfarin) or antiplatelet medications (like aspirin). This is particularly important in individuals who are undergoing surgery or have bleeding disorders, as it can result in excessive bleeding or complications. Healthcare providers need to be aware of this effect when managing patients who take ginkgo biloba.

Why Other Options Are Wrong:

Prevention of migraine headaches

This is incorrect. While some herbal remedies, like feverfew, are used for migraine prevention, there is no substantial evidence supporting Ginkgo biloba’s effectiveness in preventing migraines. Its primary use is related to cognitive function and blood flow, not headache management.

Increased risk of deep-vein thrombosis

This is incorrect. Ginkgo biloba actually decreases platelet aggregation, which can reduce the likelihood of clot formation, not increase it. Therefore, it is not associated with an increased risk of deep-vein thrombosis (DVT); rather, it may have a protective effect against clotting in some cases.

Lowered cholesterol and triglyceride levels

This is incorrect. While certain supplements are known to affect lipid levels (like garlic or red yeast rice), Ginkgo biloba does not have a significant impact on cholesterol or triglycerides. Its main effects are related to cognitive enhancement and vascular health, not lipid regulation.

Correct Answer:

Platelets 78,000/mm³

Explanation:

A platelet count of 78,000/mm³ is below the normal range of 150,000–400,000/mm³ and indicates thrombocytopenia. This is a common and potentially serious adverse effect of methotrexate, a chemotherapeutic and immunosuppressive agent. Thrombocytopenia increases the risk of bleeding, which can become dangerous if platelet levels continue to fall. In clients receiving chemotherapy, platelet counts below 100,000/mm³ warrant close monitoring, and counts under 80,000/mm³ typically require immediate reporting to the provider. Prompt intervention may include dose adjustment or treatment delay to prevent hemorrhagic complications.

Why Other Options Are Wrong:

BUN 18 mg/dL

This is incorrect because a blood urea nitrogen (BUN) level of 18 mg/dL falls within the normal range of approximately 10–20 mg/dL. Although methotrexate can affect renal function, this value does not indicate kidney impairment. There is no need to report this result as an abnormal finding. The nurse should focus on values that are outside expected ranges and pose clinical concerns, which is not the case here.

Hemoglobin 14.2 g/dL

This is not a concern because it is within the normal hemoglobin range for adults, which is generally 13.5–17.5 g/dL for males and 12.0–15.5 g/dL for females. While chemotherapy can suppress bone marrow and lead to anemia, this client’s hemoglobin level does not reflect that. There is no indication of impaired oxygen-carrying capacity or need for intervention based on this result. Reporting it would be unnecessary and would divert attention from more urgent findings.

Aspartate aminotransferase (AST) 35 units/L

This is a normal value for AST, which typically ranges from about 10 to 40 units/L. Methotrexate has the potential for hepatotoxicity, and elevated liver enzymes would warrant concern. However, since the AST level is within the expected range, it does not suggest liver damage in this case. Monitoring continues, but no immediate action or provider notification is necessary based solely on this value.

Correct Answer:

Dizziness

Explanation:

Zolpidem, a non-benzodiazepine hypnotic used for insomnia, enhances GABA activity in the CNS, which can cause dizziness, especially in older adults. Dizziness increases the risk of falls and injuries, making it a key symptom to monitor in these patients. Other CNS effects such as daytime drowsiness, confusion, and impaired coordination may also occur. Given these risks, it’s important to implement fall precautions and closely observe older clients on zolpidem.

Why Other Options Are Wrong:

Ecchymosis

This is incorrect because zolpidem is not associated with bleeding or bruising. Medications that affect clotting or liver function are more likely to cause ecchymosis.

Decreased urine output

This is incorrect because zolpidem does not affect renal function or cause oliguria. Decreased urine output is more likely due to other conditions or medications, not zolpidem.

Increased blood pressure

This is incorrect because zolpidem does not typically cause increased blood pressure. It may even cause slight hypotension due to its CNS depressant effects. Hypertension is not a known side effect of zolpidem.

Correct Answer B. Respiratory rate

Explanation of Correct Answer:

B. Respiratory rate

Propofol is a sedative and anesthetic agent that can cause respiratory depression, even at therapeutic doses. It is critical for the nurse to monitor the client's respiratory rate closely during and after administration. A decrease in the respiratory rate or signs of respiratory distress can indicate the need for intervention, such as providing supplemental oxygen or supporting the airway.

Why the Other Options Are Incorrect:

A. Pain level

This is incorrect because propofol is used for sedation during procedures like a colonoscopy, and the patient should not experience significant pain during the procedure itself. While pain should be assessed post-procedure, it is not the priority while the client is under sedation.

C. Blood pressure

This is incorrect because while propofol can cause hypotension, respiratory monitoring takes priority as respiratory depression is a more immediate and life-threatening concern. Blood pressure should still be monitored, but it is secondary to ensuring adequate respiratory function.

D. Temperature

This is incorrect because temperature changes are not typically a major concern immediately after propofol administration, unless there are signs of infection or other complications. Respiratory function remains the priority.

Correct Answer:

Piperacillin

Explanation:

Ceftriaxone is a cephalosporin antibiotic, and piperacillin is a penicillin-class antibiotic. Both cephalosporins and penicillins share a beta-lactam ring structure, which makes them chemically similar. Because of this structural similarity, individuals who have a severe allergy to one type of beta-lactam antibiotic (like penicillin) are at increased risk of cross-reactivity to another beta-lactam antibiotic (such as ceftriaxone). A severe allergic reaction, including anaphylaxis, to piperacillin or any penicillin would be a contraindication for ceftriaxone use due to the risk of experiencing a similar life-threatening reaction. Therefore, clients with a history of severe penicillin allergies should avoid ceftriaxone.

Why Other Options Are Wrong:

Gentamicin

This is incorrect because gentamicin is an aminoglycoside antibiotic. Aminoglycosides do not share the beta-lactam ring structure with cephalosporins and penicillins, so there is no known cross-reactivity between gentamicin and ceftriaxone. Therefore, a severe allergy to gentamicin does not contraindicate the use of ceftriaxone.

Clindamycin

This is incorrect because clindamycin is a lincosamide antibiotic, which is structurally and chemically unrelated to cephalosporins. An allergy to clindamycin does not indicate any risk for a reaction to ceftriaxone. The two classes of antibiotics work through different mechanisms and do not share cross-reactivity.

Sulfamethoxazole-trimethoprim

This is incorrect because sulfamethoxazole-trimethoprim is a sulfonamide combination antibiotic. Sulfonamide allergies are unrelated to the beta-lactam structure found in cephalosporins and penicillins. As such, an allergy to sulfamethoxazole-trimethoprim does not contraindicate the use of ceftriaxone.

Summary:

A severe allergy to piperacillin, a penicillin-class antibiotic, is a contraindication to ceftriaxone due to the risk of cross-sensitivity between beta-lactam antibiotics. Other antibiotics such as gentamicin, clindamycin, and sulfamethoxazole-trimethoprim do not share this cross-reactivity and do not contraindicate ceftriaxone use.

Correct Answer D. Blood pressure

Explanation of Correct Answer:

D. Blood pressure

Nifedipine is a calcium channel blocker that is commonly used to treat hypertension and angina. Since nifedipine works by dilating blood vessels, it can significantly lower blood pressure. Before administering nifedipine, the nurse should assess the client's blood pressure to ensure it is within a safe range, as the medication can cause hypotension (low blood pressure), especially in clients who are already on antihypertensive therapy or have compromised cardiac function.

Why the Other Options Are Incorrect:

A. Respiratory rate

Nifedipine does not typically affect the respiratory system, so monitoring the respiratory rate is not a priority when administering this medication. Respiratory assessment is more relevant for medications that affect the lungs or airway.

B. Temperature

Temperature is not directly affected by nifedipine. This medication is not typically associated with fever or other temperature changes, so assessing the temperature is not required as part of the routine evaluation for nifedipine administration.

C. Oxygen saturation

Oxygen saturation is important to assess in certain conditions, such as respiratory distress or when administering medications that affect the lungs or cardiovascular function. However, nifedipine primarily affects the cardiovascular system, specifically by lowering blood pressure, and does not have a direct impact on oxygenation or respiratory function.

Correct Answer:

Assess the client's apical pulse

Explanation:

When a medication error occurs, the nurse's priority is to assess the client to identify any immediate or potential adverse effects. In this case, digoxin has a narrow therapeutic window, meaning that small changes in dosage can result in significant toxicity. Bradycardia (a slow heart rate) is a common and serious side effect of digoxin overdose. The first action is to assess the client’s apical pulse to check for bradycardia or arrhythmias, which are signs of digoxin toxicity. In addition to bradycardia, digoxin toxicity can manifest as nausea, vomiting, and visual disturbances, so a thorough assessment is crucial. This step aligns with the nursing process, where assessment always precedes further interventions and actions.

Why Other Options Are Wrong:

Notify the provider

While notifying the provider is essential, it should occur after the client is assessed. The provider will need specific information such as vital signs and the client's current condition in order to make an informed decision on the next steps. Immediate assessment allows the nurse to gather critical data to share with the provider and ensure that the appropriate course of action can be taken promptly.

Contact the nursing supervisor

Contacting the nursing supervisor is part of institutional protocol but should not be the nurse's first action. The immediate priority is to assess the client's condition to determine if there are any life-threatening effects from the medication error. Once the client's condition is assessed, then the nurse can follow up with the supervisor as part of the documentation and error reporting process.

Complete an incident report

Completing an incident report is important for tracking medication errors and improving safety protocols, but it is not an immediate priority. The primary concern is the client's health and safety, and this can only be ensured by conducting a thorough assessment of their current condition. An incident report should be completed after the client's health has been assessed and appropriate interventions have been implemented.