RN Pharmacology BSN 315

Correct Answer: Sucralfate (Carafate).

 Explanation

 Sucralfate (Carafate)

Sucralfate is a gastrointestinal protectant that works by coating the stomach lining. It contains aluminum salts, and when taken with tetracycline antibiotics like tetracycline hydrochloride (Sumycin), it can bind to the tetracycline in the stomach and intestines, forming insoluble complexes. These complexes prevent the proper absorption of tetracycline into the bloodstream, which decreases the effectiveness of the antibiotic. To avoid this interaction, tetracycline and sucralfate should be taken at least two hours apart.

Why the Other Options Are Incorrect:

Hydrochlorothiazide (Diuril)

Hydrochlorothiazide is a thiazide diuretic used to treat high blood pressure and fluid retention. While it can have interactions with some medications, it does not significantly interfere with tetracycline absorption.

 Acetaminophen (Tylenol)

Acetaminophen is a pain reliever and fever reducer. It is not known to interfere with the absorption of tetracycline and can generally be taken safely alongside antibiotics.

Phenytoin (Dilantin)

Phenytoin is an anticonvulsant. It can affect the metabolism of some drugs through liver enzyme induction, but it does not directly interfere with tetracycline absorption in the gastrointestinal tract like sucralfate does. However, long-term phenytoin use might decrease the effectiveness of some antibiotics, but not via absorption issues.

Summary:

The primary concern with tetracycline antibiotics like Sumycin is interference from substances that contain metal ions or compounds (like calcium, magnesium, iron, and aluminum), which bind to the antibiotic and reduce absorption. Sucralfate (Carafate) is one such medication due to its aluminum content. Therefore, the correct answer is  Sucralfate (Carafate).

Correct Answer: Digoxin and furosemide daily since 1996.

Explanation 

The most significant data in this case is the fact that the client has been taking digoxin and furosemide daily. This is critical because the client's symptoms of nausea, vomiting, and anorexia are classic early signs of digoxin toxicity. In elderly clients, the risk of digoxin toxicity is especially high due to:

Decreased kidney function with age, which reduces the clearance of digoxin from the body.

Furosemide, a loop diuretic, can cause hypokalemia (low potassium levels). Low potassium enhances digoxin's effects, increasing the risk of toxicity.

Digoxin toxicity does not always start with heart-related symptoms. It often first presents with gastrointestinal symptoms like nausea, vomiting, anorexia, and later can progress to visual disturbances and arrhythmias.

Because of these factors, recognizing the client's long-term use of both digoxin and furosemide is critical in planning care, as the nurse should anticipate checking serum digoxin levels, electrolytes (especially potassium), and renal function, while closely monitoring for worsening signs of toxicity.

Why the other options are incorrect:

Coronary artery bypass procedure was performed in 1995

While heart history is important, a surgery from nearly thirty years ago is less immediately relevant to the current symptoms. The bypass may relate to the client's heart failure history, but it does not directly explain the acute symptoms of nausea, vomiting, and anorexia.

Colonoscopy performed for routine screening six months ago

This is not relevant to the current symptoms. A routine colonoscopy is unrelated to nausea and vomiting unless complications occurred, which are not indicated here

 Suffered with depression following death of spouse in 1999

While emotional health and history of depression are important, there is no indication that the client's current symptoms are psychological in nature. They are more suggestive of a physical cause, and the digoxin-furosemide combination is a much stronger and more urgent concern.

Summary

The correct answer is Digoxin and furosemide daily since 1996., because the combination of digoxin and furosemide in an elderly client with symptoms like nausea, vomiting, and anorexia raises a high suspicion for digoxin toxicity, which requires immediate attention. The other options are either historical or unrelated to the current acute symptoms and do not affect immediate care planning.

Correct Answer: The patient is adhering to the medication plan

Explanation:

Hemoglobin A1C (HbA1C) measures average blood glucose levels over 2–3 months. An A1C of 6% corresponds to an estimated average blood glucose of about 126 mg/dL, which is within the target range for diabetic patients. The goal for most diabetics is an A1C below 7% (as recommended by the ADA - American Diabetes Association). Since the patient’s A1C is well-controlled, this suggests good adherence to the medication and treatment plan.

Why the Other Options Are Incorrect:

The patient takes her medication some days

If the patient inconsistently took medication, A1C levels would likely be higher than 6%, indicating poor blood sugar control.

The patient is taking too much medication 

An A1C too low (<5.7%) might indicate excessive medication use or hypoglycemia risk, but 6% is within the controlled range.

The patient has stopped taking her medication 

If the patient had stopped taking medication, A1C would likely be higher than 6%, often above 8-9%, reflecting poor control.

Summary:

Since an A1C of 6% is within the recommended target range for diabetes management, the correct answer is The patient is adhering to the medication plan.

Correct Answer: Administer the carbamazepine as prescribed.

Explanation

The reference range for carbamazepine levels is 4 to 12 mcg/mL (16.9 to 50.8 mcmol/L), and the client's morning carbamazepine level was 8.4 mcg/mL (35.6 mcmol/L), which falls within this reference range. This indicates that the client’s current carbamazepine level is within the therapeutic range, and therefore, there is no immediate concern regarding toxicity or underdosing. Administering the carbamazepine as prescribed is appropriate at this time.

Why the other options are wrong:

Withhold this dose of carbamazepine: Withholding the dose is not necessary because the client's carbamazepine level is within the therapeutic range. Withholding the dose could lead to subtherapeutic levels and potential seizure activity or recurrence of the condition being treated.

Notify the healthcare provider of the carbamazepine level: While notifying the healthcare provider may be necessary if there were signs of toxicity or if the level were outside the therapeutic range, in this case, the level is within the normal therapeutic range, so immediate notification is not required. The nurse should continue to monitor the client but does not need to alert the healthcare provider at this time.

Assess the client for side effects of carbamazepine: Assessing the client for side effects is always important when administering medications, but in this case, the carbamazepine level is within the normal therapeutic range, so the risk of side effects due to toxicity is low. However, routine assessment for side effects is part of ongoing care, but it is not the most urgent action in this situation.

Summary:

The client’s carbamazepine level is within the therapeutic range, and there are no indications to withhold the medication or notify the healthcare provider at this time. Therefore, the nurse should administer the carbamazepine as prescribed (Option b). Regular monitoring for side effects and continued assessments should be done, but there is no need to take any other immediate action.

Correct Answer: Black stools.

Explanation

Warfarin is an anticoagulant (blood thinner) prescribed to prevent the formation of blood clots. Because it interferes with the body's ability to form clots, the most serious side effect of warfarin is bleeding. One of the critical signs of internal bleeding, especially in the gastrointestinal (GI) tract, is black, tarry stools. These dark stools, medically known as melena, indicate the presence of digested blood coming from bleeding in the upper GI tract. Black stools are a serious finding in a patient taking warfarin and should be reported to the healthcare provider immediately. Monitoring for bleeding is the highest priority with warfarin. In addition to black stools, nurses should assess for other signs of bleeding, such as bruising, nosebleeds, bleeding gums, blood in urine, prolonged bleeding from cuts, and unusual headaches (which could signal brain bleeding).

Why the Other Options Are Incorrect:

Constipation

 Constipation is not a typical side effect of warfarin. While it is a common complaint in the general population, it is not directly linked to the anticoagulant effects of warfarin

 Abdominal bloating

While abdominal discomfort could occur for various reasons, bloating is not a common or direct side effect of warfarin therapy. Abdominal pain or swelling would be more concerning if it were due to internal bleeding, but bloating alone is not specific to warfarin use.

Back pain

Back pain can occur for many reasons, but it is not a common or expected side effect of warfarin. However, if back pain is severe and sudden, in rare cases, it could indicate internal bleeding (such as retroperitoneal bleeding), but this is less common than the more obvious signs like black stools or bleeding gums.

Summary:

The correct answer is black stools because they are a key indicator of possible internal gastrointestinal bleeding, which is a major risk of warfarin therapy. The other options, including constipation, abdominal bloating, and back pain, are not typical side effects directly associated with warfarin. The priority with warfarin is always monitoring for any signs of bleeding to prevent serious complications.

Correct Answer: Oral.

Explanation:

The first-pass effect refers to the metabolism of a drug as it passes through the liver after being absorbed from the gastrointestinal tract. Drugs administered orally are absorbed through the digestive system and then pass through the liver, where a significant amount of the drug may be metabolized before reaching systemic circulation. This process reduces the bioavailability of the drug.

Why the other options are incorrect:

Sublingual 

Medications given sublingually (under the tongue) bypass the liver initially and enter directly into the bloodstream through the mucous membranes of the mouth. This method avoids the first-pass effect and provides a faster onset of action compared to oral administration.

Intravenous 

Medications administered intravenously (IV) are delivered directly into the bloodstream, bypassing the gastrointestinal tract and liver. Therefore, IV administration does not undergo the first-pass effect, and the full dose of the drug reaches systemic circulation immediately.

Subcutaneous 

Drugs given subcutaneously (injected into the layer of fat beneath the skin) are absorbed into the bloodstream, but they bypass the liver initially. This method also does not undergo the first-pass effect.

Summary:

Oral administration provides the greatest first-pass effect, as the drug must pass through the liver after being absorbed from the gastrointestinal tract, where it is metabolized before reaching systemic circulation.

Correct Answer: Advise the client to take the medication in the morning, rather than at bedtime.

Explanation

Advise the client to take the medication in the morning, rather than at bedtime is correct because long-term corticosteroid therapy (such as prednisone or similar steroids) should ideally be taken in the morning, preferably with food. This recommendation is based on the body's natural circadian rhythm of cortisol production, which peaks in the early morning and decreases throughout the day. By taking corticosteroids in the morning, the medication better mimics the body's natural cortisol release, which:

Reduces the risk of adrenal suppression.

Minimizes side effects like insomnia, nighttime restlessness, and mood disturbances.

Decreases long-term complications from disrupting the body’s hormonal cycles.

Taking corticosteroids at bedtime can lead to difficulty sleeping and may interfere with the body's ability to maintain a normal hormone rhythm. Therefore, the nurse's best response is to educate the client to switch the timing of the dose to the morning with food (such as crackers and milk), which also helps reduce the risk of gastrointestinal upset.

 Why the Other Options Are Wrong:

Teach the client that dairy products should not be taken with her medication is incorrect.

Dairy products are not contraindicated with corticosteroids. In fact, taking corticosteroids with food, including dairy, can help protect the stomach lining and reduce the risk of gastric irritation or ulcers, which are common with long-term steroid use. Therefore, there is no need to avoid crackers and milk.

Tell the client that absorption is improved when taken on an empty stomach is incorrect.

Corticosteroids do not need to be taken on an empty stomach. In fact, they are often recommended to be taken with food to help prevent gastrointestinal irritation, nausea, and ulcer formation. So, taking the medication with a snack is appropriate, just at the wrong time of day.

Affirm that the client has a safe and effective routine for taking the medication is incorrect.

While it is good that the client takes the medication with food, taking corticosteroids at bedtime is not recommended due to the risk of disrupting natural cortisol cycles and causing insomnia or other side effects. Therefore, affirming the current bedtime routine would reinforce incorrect practice.

Summary:

The correct answer is Advise the client to take the medication in the morning, rather than at bedtime because corticosteroids should follow the body's natural cortisol cycle to minimize side effects and hormonal disruption. The other options are incorrect because dairy products are acceptable with corticosteroids, the medication does not need to be taken on an empty stomach, and the client’s current bedtime dosing routine is not safe or best practice. Proper education on timing is essential to protect the client from complications of long-term corticosteroid therapy.

Correct Answer: Inform the client that the medication has been effective.

Explanation 

Filgrastim is a granulocyte colony-stimulating factor (G-CSF) that is used to stimulate the production of white blood cells, particularly neutrophils, in clients who are at risk for neutropenia. Neutropenia is a condition characterized by abnormally low levels of neutrophils, which increases the risk of infection. The goal of filgrastim therapy is to elevate the white blood cell count to within the normal reference range and reduce the client’s infection risk. In this case, the client's white blood cell count increased from two thousand five hundred per cubic millimeter to five thousand per cubic millimeter, which is the lower limit of the normal reference range of five thousand to ten thousand per cubic millimeter. This indicates that the medication has successfully elevated the client's white blood cell count from an abnormally low level to a safe, normal range. Therefore, the appropriate action is to inform the client that the filgrastim has been effective in restoring their white blood cell count to a healthy level.

Why the other options are incorrect:

Review the client's culture and sensitivity reports.

This action is not necessary in response to an improved white blood cell count. Reviewing culture and sensitivity reports is important if there is an active infection or suspicion of infection to guide antibiotic therapy. However, in this situation, there is no indication of infection or concern requiring culture review. The focus here is on the success of filgrastim in increasing white blood cells, not on managing an infection.

 Implement neutropenic precautions.

Neutropenic precautions are measures used to protect clients who have severely low white blood cell counts and are at high risk of infection. These precautions are typically implemented when the white blood cell count is below one thousand per cubic millimeter or when neutropenia is severe. Since the client’s count has risen to five thousand per cubic millimeter, which is normal, neutropenic precautions are no longer indicated and would not be appropriate in this case.

 Assess the client's vital signs.

While assessing vital signs is always a routine nursing task, there is nothing in the scenario suggesting an immediate need to check vital signs based on the improvement of the white blood cell count. Vital sign checks are standard care, but they are not the priority response to a successfully increased white blood cell count after filgrastim therapy.

Summary:

The correct answer is to inform the client that the medication has been effective because the white blood cell count has returned to the normal range after filgrastim treatment. This demonstrates the desired therapeutic outcome. The other options are incorrect because they either address concerns not supported by the data (such as infection management or neutropenic precautions) or describe routine care that is not specific to the success of the treatment. The priority in this scenario is to acknowledge the positive result and educate the client about the effectiveness of their therapy.

Correct Answer: Take and record radial pulse rate daily.

Explanation

Digoxin (Lanoxin) is a cardiac glycoside commonly prescribed to treat heart failure and atrial fibrillation. One of the most important aspects of safe digoxin therapy is monitoring for bradycardia (a slow heart rate), which can be a sign of digoxin toxicity. Therefore, the nurse should instruct the client to take their radial pulse daily, preferably at the same time each day before taking the medication, and record the pulse rate. The client should also be taught that if the pulse rate is below sixty beats per minute, they should hold the dose and contact their healthcare provider. This monitoring helps detect early signs of toxicity and prevents serious complications like dangerous arrhythmias.

Why the other options are incorrect:

Take the medication in the morning before rising.

This is incorrect because digoxin timing is not dependent on waking up or rising from bed. It is generally recommended to take digoxin at the same time every day, but it does not need to be taken before getting out of bed. Consistency with timing is important, but this statement is not accurate patient teaching.

Expect some vision changes caused by the medication.

This is incorrect because vision changes (such as blurred vision, yellow-green halos, or other disturbances) are actually signs of digoxin toxicity, not normal side effects to expect. If the client experiences vision changes, they should immediately report this to their healthcare provider, as it may indicate dangerous digoxin levels. Telling the patient to "expect" vision changes would delay necessary medical attention for toxicity.

 Increase intake of foods rich in vitamin K.

This is incorrect because vitamin K is important for reversing the effects of anticoagulants like warfarin (Coumadin), but it has no direct relationship with digoxin therapy. Increasing vitamin K intake is not necessary or helpful for someone taking digoxin.

Summary:

The most critical teaching for a client taking digoxin is to monitor their radial pulse daily and record it, holding the medication and notifying the provider if the pulse drops below sixty beats per minute. This helps prevent digoxin toxicity, which can be life-threatening.

The other options (timing before rising, expecting vision changes, and increasing vitamin K intake) are incorrect or misleading.