ATI Pharmacology Exam

Correct Answer: Morphine 6 mg IV push every 3 hr PRN acute pain

Explanation:

This transcription adheres to the best practices for safe medication documentation. The full name of the medication ("morphine") is used instead of abbreviations, preventing misinterpretation. The dose is written clearly as "6 mg", avoiding trailing zeros, which can lead to dangerous dosing errors. The route, frequency, and indication are explicitly stated, ensuring clarity and reducing the risk of errors. This format aligns with The Joint Commission’s safety standards and promotes accurate communication in the medical record.

Why Other Options are Wrong:

MSO 6 mg IV push every 3 hr PRN acute pain

The abbreviation "MSO" is not a standard and could easily be confused with other medications, such as magnesium sulfate. The use of non-standard abbreviations is discouraged due to the risk of misinterpretation and medication errors.

MS 6 mg IV push every 3 hr PRN acute pain

"MS" is an unsafe abbreviation that can be confused with morphine sulfate or magnesium sulfate, both of which have very different pharmacological effects. This abbreviation is prohibited by The Joint Commission due to its potential for causing serious errors.

Morphine 6.0 mg IV push every 3 hr PRN acute pain

Although the medication name and route are correct, the use of a trailing zero ("6.0 mg") is dangerous. Trailing zeros can lead to a 10-fold dosing error if the decimal point is overlooked. The correct and safest practice is to document "6 mg" without the trailing zero.

Correct Answer:

Nifedipine

Explanation:

Nifedipine is a calcium channel blocker commonly used as a tocolytic agent to suppress preterm labor. It works by relaxing the smooth muscle of the uterus, thereby inhibiting uterine contractions. This is crucial in managing preterm labor, particularly between 24 and 34 weeks of gestation, as it can delay delivery long enough to administer interventions such as corticosteroids for fetal lung maturity. Nifedipine is effective in stopping contractions and preventing premature birth in many cases, providing essential time for the development of the fetus.

Why Other Options Are Wrong:

Oxytocin

This is incorrect because oxytocin is used to induce or augment labor, not stop it. It stimulates uterine contractions, and its use in a patient experiencing preterm labor would exacerbate the situation. Administering oxytocin in this scenario would not be appropriate and is contraindicated in preterm labor management.

Dinoprostone

Dinoprostone is a prostaglandin used to ripen the cervix and induce labor. Like oxytocin, it promotes uterine contractions and is contraindicated in the treatment of preterm labor. It would not be appropriate for a client at risk for preterm delivery, as it would stimulate further contractions and potentially lead to earlier delivery.

Misoprostol

Misoprostol, also a prostaglandin, is used for cervical ripening and labor induction, similar to dinoprostone. Its primary action is to induce contractions, which would be counterproductive and harmful in the case of preterm labor. The goal in preterm labor is to suppress contractions, not to promote them, making misoprostol inappropriate for this scenario.

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:

Aspirate to check the IV patency before administering the diphenhydramine

Explanation:

Before administering any IV medication, particularly an IV bolus like diphenhydramine, it is essential to ensure that the IV line is patent. This is done by aspirating to check for blood return and flushing the line with saline to confirm it is functioning properly. This step is necessary to ensure the medication will be delivered into the vein and not into surrounding tissues, which could cause complications like irritation, infiltration, or ineffective delivery. For diphenhydramine, which can irritate the tissues, confirming the IV is patent is especially crucial. Additionally, flushing the line with normal saline before and after administration helps to prevent incompatibility with any other drugs in the line.

Why Other Options Are Incorrect:

Choose an IV port for IV bolus injection for the diphenhydramine as near as possible to the client's hanging IV bag

This is incorrect because injecting diphenhydramine too close to the IV bag may cause the drugs to mix immediately, increasing the risk of incompatibility between diphenhydramine and the ongoing IV medication. This could lead to precipitation or inactivation of one or both drugs.

Flush the IV tubing with 2 mL of 0.9% sodium chloride before and after administering diphenhydramine

This is incorrect because the volume used to flush the line is insufficient. The standard practice is to flush with at least 5-10 mL of saline to ensure the IV line is thoroughly cleared and to prevent drug interactions. This should follow the confirmation of IV patency.

Allow IV infusion to keep running while administering the diphenhydramine via IV bolus

This is incorrect because running the infusion while administering diphenhydramine would allow the two medications to mix, which could cause harmful interactions. If incompatibility between the drugs is known, the medications should not be administered together in the same line without flushing.

Correct Answer: Laryngeal edema

Explanation:

Laryngeal edema is a serious and potentially life-threatening symptom of an allergic reaction, specifically anaphylaxis, which may occur in response to medications like amoxicillin. It involves swelling in the tissues of the larynx (voice box), which can obstruct the airway and lead to respiratory distress or failure. Recognizing this symptom early is critical, as prompt treatment with epinephrine and airway management can be lifesaving. Laryngeal edema is considered a hallmark feature of a severe allergic reaction and requires emergency intervention.

Why Other Options are Wrong:

Nausea

This is incorrect. Nausea is a relatively common and nonspecific side effect of many medications, including amoxicillin. It may occur without indicating an allergic reaction and is usually mild and self-limiting. While nausea can occasionally be part of a systemic response, it is not diagnostic of a hypersensitivity reaction unless it occurs with more definitive signs such as rash, hives, or airway involvement.

Cardiac dysrhythmia

This is incorrect. Cardiac dysrhythmias are not a primary feature of an allergic reaction to amoxicillin. Though severe anaphylaxis might result in cardiovascular collapse, including hypotension and secondary arrhythmias, these are typically the result of profound systemic effects rather than direct signs of allergy. Dysrhythmias more commonly result from cardiac conditions or medications that directly affect cardiac conduction.

Insomnia

This is incorrect. Insomnia is not associated with allergic reactions to amoxicillin and is not a recognized adverse effect of this antibiotic. It may be due to other unrelated causes, such as anxiety, caffeine use, or underlying sleep disorders, but it does not suggest a hypersensitivity response and does not warrant emergency intervention.

Summary:

Laryngeal edema is the most critical indicator of an allergic reaction to amoxicillin and demands immediate medical action. The other symptoms listed—nausea, cardiac dysrhythmia, and insomnia—do not specifically point to an allergic reaction and are not reliable indicators of hypersensitivity.

Correct Answer:

Rifampin can turn body fluids orange.

Explanation:

Rifampin is an antibiotic commonly used to treat tuberculosis (TB). One well-known side effect of rifampin is that it can cause body fluids (such as urine, sweat, saliva, and tears) to turn a reddish-orange color. This is harmless and is a normal, expected effect of the medication. It is not a sign of toxicity and does not require stopping the medication. The nurse should reassure the client that this is a temporary and harmless side effect.

Why Other Options Are Incorrect:

Stop taking isoniazid for 3 days and the discoloration should go away

This is incorrect because isoniazid is not responsible for the orange discoloration; rifampin is. Stopping any tuberculosis medication without provider guidance can lead to treatment failure and drug resistance, which is dangerous.

I'll make an appointment for you to see the provider this afternoon

While it's important to report unexpected symptoms, orange urine due to rifampin is a known, expected side effect and does not require immediate medical attention. Scheduling an urgent visit would unnecessarily worry the client.

Isoniazid can cause bladder distention

This is incorrect. Isoniazid, one of the medications used to treat tuberculosis, does not cause bladder distention. Its known side effects include hepatotoxicity and peripheral neuropathy, but bladder distention is not one of them.

Correct Answer D. Hyperkalemia

Explanation of Correct Answer:

D. Hyperkalemia

Potassium chloride is used to treat hypokalemia (low potassium levels), but it is important to monitor potassium levels during administration because excessive potassium can cause hyperkalemia, a dangerous condition where the potassium levels in the blood become too high. Hyperkalemia can cause serious complications such as cardiac arrhythmias and cardiac arrest. If the client develops hyperkalemia, the nurse should discontinue the infusion immediately and notify the healthcare provider.

Why the Other Options Are Incorrect:

A. Hypomagnesemia

While hypomagnesemia can be associated with low potassium levels, it does not directly indicate the need to stop a potassium chloride infusion. However, hypomagnesemia should be monitored, and magnesium supplementation may be necessary alongside potassium replacement.

B. Coughing

Coughing is generally not a direct indication to stop a potassium chloride infusion. If the client is coughing, it could be due to other reasons such as a respiratory infection, but it is not an automatic indication to discontinue the infusion.

C. Neutropenia

Neutropenia (low white blood cell count) is not a common direct complication of potassium chloride infusion. While it could be a side effect of other medications or conditions, it is not a reason to stop the potassium chloride infusion unless there is a different underlying cause or medication that is contributing to neutropenia.

Correct Answer:

0745

Explanation:

Insulin glulisine is a rapid-acting insulin analog that begins working quickly after administration, typically within 10 to 15 minutes. If the insulin was administered at 0720, its effects would start to take effect around 0745, making this the expected onset time. Rapid-acting insulins are designed to mimic the natural insulin response to meals, which is why they should be given shortly before or after eating to avoid hypoglycemia. This medication has an onset of approximately 10-15 minutes, a peak around 1 hour, and a duration of action lasting 3–5 hours.

Why Other Options Are Wrong:

0800

This is incorrect because 0800 is 40 minutes after the insulin was administered at 0720. This time is closer to the peak of insulin activity rather than the onset, which typically occurs much sooner—around 0745—due to the rapid action of the insulin.

0900

This is incorrect because by 0900, which is 1 hour and 40 minutes after administration, the insulin would likely be near or at its peak effect, not at the onset. The onset of action happens much sooner, in the first 10-15 minutes following injection.

1030

This is incorrect as 1030 is more than 3 hours after administration, which is toward the end of insulin glulisine’s duration of action. By this time, the insulin’s effects would have started to wear off, and it would not be considered the onset. The onset occurs much earlier, around 0745.

Correct Answer:

Promotes RBC production

Explanation:

Epoetin alfa is a synthetic version of erythropoietin, a hormone normally produced by the kidneys that stimulates red blood cell (RBC) production in the bone marrow. In clients with chronic kidney failure, the kidneys are often unable to produce sufficient erythropoietin, which leads to anemia. Epoetin alfa helps correct this anemia by stimulating the production of RBCs, improving the oxygen-carrying capacity of the blood, and reducing the need for blood transfusions.

Why Other Options Are Wrong:

Reduces blood pressure

This is incorrect because epoetin alfa does not lower blood pressure. In fact, it can sometimes cause hypertension, especially if hematocrit levels rise too quickly, so blood pressure should be closely monitored in clients receiving this medication.

Inhibits clotting of fistula

This is incorrect because epoetin alfa does not have any anticoagulant or antiplatelet effects. It does not prevent clotting of an arteriovenous fistula. Management of fistula clotting involves proper care, monitoring, and sometimes the use of anticoagulants, not epoetin alfa.

Stimulates growth of neutrophils

This is incorrect because stimulating neutrophil production is the role of filgrastim, not epoetin alfa. Epoetin alfa specifically stimulates red blood cell production, not white blood cells or neutrophils.