ATI Pharmacology Exam

Correct Answer:

I will watch for increased breast tissue growth while taking this medication.

Explanation:

This is the correct answer. Spironolactone is a potassium-sparing diuretic and an aldosterone antagonist that is used to manage conditions such as heart failure, hypertension, and ascites. A known side effect of spironolactone is gynecomastia, which is the development of breast tissue in men, and in some cases, it can cause breast tenderness in women. This occurs because spironolactone has anti-androgenic properties, meaning it blocks the action of male hormones like testosterone and can sometimes increase the effects of estrogen. Monitoring for breast tissue growth or tenderness is a crucial part of patient education while taking spironolactone, and the client should report any changes. This shows an understanding of the medication's potential endocrine-related adverse effects.

Why Other Options Are Wrong:

I will increase my intake of citrus fruits, bananas, and potatoes.

This is incorrect because citrus fruits, bananas, and potatoes are all high in potassium. Spironolactone is a potassium-sparing diuretic, meaning it prevents the body from excreting potassium, which could lead to hyperkalemia (high potassium levels). Hyperkalemia can cause dangerous heart arrhythmias, and consuming more potassium-rich foods would exacerbate this risk. Therefore, the client should limit potassium intake or monitor it carefully, not increase it.

I will use salt substitutes on my food.

This is incorrect because many salt substitutes contain potassium chloride, which can further elevate potassium levels when taken with a potassium-sparing diuretic like spironolactone. Excessive potassium can cause hyperkalemia, which can lead to severe cardiac issues, including arrhythmias or cardiac arrest. Clients on spironolactone should avoid salt substitutes unless specifically directed by their healthcare provider.

I will drink as much water as I can while taking this medication.

This is incorrect because, while staying hydrated is important, excessive water intake can lead to dilutional hyponatremia (low sodium levels), which disrupts the electrolyte balance. For clients with heart failure or kidney conditions, too much fluid intake can lead to volume overload, causing symptoms like swelling, shortness of breath, and exacerbating heart failure. Fluid intake should be carefully monitored and regulated based on the client's specific medical needs and the provider's instructions.

Summary:

Spironolactone can cause hormonal side effects like gynecomastia, so it is crucial for the client to be aware of this potential change and report it. The other options promote behaviors that could increase potassium levels or fluid overload, both of which pose significant risks when taking spironolactone. The correct teaching focuses on the medication's known endocrine-related side effects.

Correct Answer:

Ambulate the client to a chair prior to administering the medication

Explanation:

Alendronate is a bisphosphonate used to treat conditions like Paget’s disease and osteoporosis. One of the major risks of taking alendronate is esophagitis or esophageal ulceration, especially if the client lies down shortly after taking the medication. To prevent this, the client must remain upright (sitting or standing) for at least 30 minutes after taking the medication. Therefore, the priority action is to ambulate the client to a chair or ensure they are upright to minimize the risk of serious complications like esophageal injury.

Why Other Options Are Incorrect:

Administer the medication to the client before breakfast in the morning

While this is true (alendronate should be taken first thing in the morning, on an empty stomach), ensuring the client is upright is the more immediate concern to prevent esophageal damage. This step comes second after ensuring the client is in an appropriate position.

Give the medication to the client with water rather than milk

This is also correct (alendronate should be taken with a full glass of water and not milk or other beverages that could interfere with absorption). However, positioning the client upright is the more urgent priority.

Teach the client how to take the medication at home

While patient education is important, ensuring the client's safety by preventing esophageal complications is the immediate priority when administering the medication. Education can be provided afterward.

Correct Answer: INR 5.5

Explanation:

The International Normalized Ratio (INR) is used to monitor the anticoagulant effect of warfarin. For a client with atrial fibrillation, the therapeutic INR range is generally between 2.0 and 3.0. An INR of 5.5 is significantly higher than the therapeutic range, which means the client is at an increased risk of bleeding. This is considered a critical value and warrants immediate reporting to the provider. The healthcare team may need to adjust the warfarin dosage, administer vitamin K, or take other actions to lower the INR and reduce bleeding risk.

Why other options are wrong:

PT 18 seconds

Prothrombin Time (PT) measures clotting time, and a slight elevation, such as 18 seconds, may occur in patients on warfarin. This result is not alarming if the patient is on the medication, as warfarin therapy typically prolongs PT. It is not as specific or standardized as the INR and does not require immediate attention in isolation.

Platelet count 160,000

A platelet count of 160,000/mm³ is within the normal range (150,000–400,000/mm³) and indicates no issue related to bleeding or clotting. This value does not require urgent intervention or provider notification.

Hct 43%

Hematocrit (Hct) of 43% is within the normal adult range (38%–52% for males and 35%–47% for females). This value indicates a normal red blood cell concentration and is not related to the management or monitoring of warfarin therapy. It does not suggest any immediate concerns.

Correct Answer A. Medication Administration Record (MAR)

Explanation of Correct Answer:

A. Medication Administration Record (MAR)

The MAR is the most reliable resource at the point of medication administration. It contains essential information about the client’s prescribed medications, including:

Medication name

Dosage

Route

Timing/frequency

Special instructions (e.g., hold for certain vital signs)

The nurse uses the MAR to ensure that the correct medication is administered to the correct patient at the right time and in the right dose. It also serves to document any client-specific parameters or additional instructions that may affect medication administration. Therefore, it is the primary resource to ensure safe and accurate medication delivery.

Why the Other Options Are Incorrect:

B. Food and Drug Administration (FDA)

The FDA provides comprehensive drug information, such as side effects, contraindications, and dosage forms. However, it is not used for administration-specific details or tracking client-specific medication orders. The FDA is more useful for background information about the medication but not for daily administration.

C. Agency for Healthcare Research and Quality (AHRQ)

The AHRQ focuses on healthcare research and improving the quality of care, but it does not provide client-specific medication details or instructions on medication administration. It is more suited for policy development or evidence-based guidelines rather than direct medication guidance.

D. The Joint Commission (TJC)

The Joint Commission sets standards for healthcare facilities and patient safety but does not provide detailed drug information or guide medication administration. It’s more relevant for accreditation and ensuring overall safety standards, not for day-to-day medication management.

Correct Answer:

Chlordiazepoxide

Explanation:

Chlordiazepoxide is a benzodiazepine commonly used for the management of acute alcohol withdrawal syndrome (AWS). In this scenario, the client is showing early signs of alcohol withdrawal, such as tremors and restlessness. These symptoms can escalate to more severe manifestations, including seizures and delirium tremens, which can be fatal if not addressed. Chlordiazepoxide works by enhancing the activity of gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter, which has a calming effect on the central nervous system. This medication helps to reduce withdrawal symptoms such as agitation, anxiety, and seizures, making it the first-line treatment in managing acute alcohol withdrawal.

Why Other Options Are Wrong:

Acamprosate

This is incorrect because acamprosate is used after detoxification to help maintain alcohol abstinence, not to treat acute withdrawal symptoms. It works by modulating the glutamatergic system and restoring balance in the brain after chronic alcohol use, but it is ineffective during the withdrawal phase. Using acamprosate during the acute phase could delay necessary intervention for withdrawal symptoms and increase the risk of complications.

Naltrexone

This is incorrect because naltrexone is an opioid antagonist that is used primarily for alcohol dependence management after detoxification. It works by reducing alcohol cravings and blocking the pleasurable effects of alcohol. However, naltrexone does not help with the management of acute withdrawal symptoms and could potentially complicate the withdrawal process by further inhibiting the central nervous system in an already sensitive state. Therefore, naltrexone is not appropriate during the withdrawal phase.

Disulfiram

This is incorrect because disulfiram is used for alcohol aversion therapy after alcohol withdrawal has been completed. It causes unpleasant effects like nausea and vomiting if alcohol is consumed, which can help deter drinking. However, it is never used during the withdrawal phase because the client may still be at risk for alcohol use, and the drug can lead to dangerous interactions with alcohol in the system. Disulfiram should only be considered after detoxification and once the client has been abstinent from alcohol for a period of time.

Correct Answer: Creatinine clearance 50 mL/min

Explanation:

A creatinine clearance of 50 mL/min reflects moderate renal impairment. Vasopressin promotes water retention by enhancing the reabsorption of water in the renal tubules, which can lead to fluid overload in patients with compromised kidney function. In such cases, the body may not be able to excrete the retained water efficiently, increasing the risk of hyponatremia, edema, and even worsening kidney perfusion. Therefore, vasopressin should be used cautiously or avoided in patients with significant renal impairment.

Why other options are wrong:

Sodium 152

A sodium level of 152 mEq/L is above the normal range but is a typical finding in diabetes insipidus due to the excessive loss of free water. This hypernatremia supports the use of vasopressin to promote water reabsorption and restore sodium balance. It is not a contraindication but rather an indication for treatment.

Potassium 6.0

A potassium level of 6.0 mEq/L indicates hyperkalemia, which is a serious concern but not a direct contraindication to vasopressin use. While electrolyte levels should be monitored closely, vasopressin itself does not directly elevate potassium. However, fluid shifts resulting from vasopressin could impact potassium distribution, so the patient must be monitored. Still, this condition doesn’t prevent its use.

Aspartate aminotransferase (AST) 52

An AST level of 52 is mildly elevated and may indicate minor liver stress or irritation, but it is not a contraindication to vasopressin. The liver plays a role in metabolizing vasopressin, but mild elevations in AST typically do not impair drug metabolism to a degree that would make the medication unsafe. Ongoing liver function monitoring is recommended, but this result does not rule out vasopressin use.

Summary:

Vasopressin should be used cautiously or avoided in patients with impaired renal function, such as those with a creatinine clearance of 50 mL/min, due to the risk of water retention and worsening renal status. Elevated sodium levels in DI support vasopressin therapy, and mild liver enzyme elevations or hyperkalemia require monitoring but are not contraindications.

Correct Answer B. Increased sleeping

Explanation of Correct Answer:

B. Increased sleeping

Methimazole is an antithyroid medication used to treat Graves' disease, a condition that causes hyperthyroidism (excess thyroid hormone). Hyperthyroidism can lead to symptoms such as insomnia, increased energy, and restlessness. After 2 months of methimazole therapy, the client’s thyroid hormone levels should become more normalized, leading to a decrease in hyperthyroid symptoms, including improved sleep. This result reflects the medication's effectiveness in reducing thyroid hormone production.

Why the Other Options Are Incorrect:

A. Weight loss

While hyperthyroidism (Graves' disease) often leads to weight loss, methimazole helps normalize thyroid hormone levels, which typically leads to weight stabilization or weight gain, not continued weight loss.

C. Increase in pulse rate

Methimazole works to lower thyroid hormone levels, and hyperthyroidism (which causes an increased heart rate) is managed by decreasing excessive thyroid hormones. After 2 months of therapy, the client should experience a reduction in pulse rate, not an increase.

D. Warmer skin

In hyperthyroidism, increased thyroid hormone levels can cause the skin to feel warmer or more moist due to increased metabolism. However, methimazole works to decrease thyroid hormone production, which would generally result in the skin becoming cooler as the body’s metabolic rate stabilizes.

Correct Answer C. Fever

Explanation of Correct Answer:

C. Fever

Fever is one of the most common signs of an acute infusion reaction to amphotericin B. This medication can cause chills, fever, and other flu-like symptoms during or shortly after infusion. These reactions are common, particularly with the first few doses, and are part of the body's inflammatory response to the drug.

Why the Other Options Are Incorrect:

A. Dry cough

A dry cough is not a typical sign of an acute infusion reaction to amphotericin B. A cough may be more indicative of a respiratory issue or another underlying condition, but it is not specifically related to the infusion reaction.

B. Pedal edema

Pedal edema (swelling in the feet and ankles) is not a typical manifestation of an acute infusion reaction to amphotericin B. Edema could result from other conditions, including fluid retention due to renal impairment, but it is not a direct sign of an infusion reaction.

D. Hyperglycemia

Hyperglycemia is not a typical manifestation of an acute infusion reaction to amphotericin B. It may occur as a side effect of long-term steroid use or other medications, but it is not directly related to the infusion reaction.

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.