RN Pharmacology BSN 315

Correct Answer: "My mouth feels sore."

Explanation 

 "My mouth feels sore."

A sore mouth is a classic symptom of oral thrush, which is a fungal superinfection often caused by Candida albicans. Superinfections occur when normal flora are disrupted by broad-spectrum anti-infective (antibiotic) therapy, allowing overgrowth of resistant organisms like fungi or other bacteria. Common superinfections include:

Oral thrush (white patches, sore mouth)

Vaginal yeast infections

C. difficile colitis

A sore mouth or discomfort, particularly if accompanied by white patches on the tongue or inside the cheeks, is a hallmark sign of oral candidiasis, a superinfection that frequently occurs during or after antibiotic treatment.

Why the Other Options Are Incorrect:

 "I have a headache."

Headaches can happen for many reasons, but they are nonspecific and not directly indicative of a superinfection. They are also not a common or defining symptom of superinfections.

"My ears feel plugged up."

Plugged ears may relate to ear congestion, fluid buildup, or sinus issues but are not associated with superinfections caused by antibiotic use.

"I feel constipated."

Constipation is not a typical sign of a superinfection. More often, antibiotics can cause diarrhea (and in some cases severe diarrhea from C. difficile), not constipation.

Summary:

Superinfections occur when antibiotic therapy disrupts the normal balance of microorganisms, allowing overgrowth of other pathogens, particularly fungi like Candida. Sore mouth complaints raise concern for oral thrush, making "My mouth feels sore" the most appropriate answer. 

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: Question the order, because the time of day is incorrect

Explanation

Levothyroxine (Synthroid) is typically administered in the morning, on an empty stomach, at least 30 to 60 minutes before breakfast. Taking it in the evening may interfere with absorption and effectiveness, as food and other medications can alter its absorption. The nurse should clarify the order with the healthcare provider to ensure optimal timing for medication administration.

Explanation of the Incorrect Answers:

Question the order, because the dose is too high 

The ordered dose is 20 mcg (0.02 mg), which is within the standard starting range for hypothyroidism. Levothyroxine is commonly prescribed in doses ranging from 12.5 mcg to 200 mcg, depending on the patient’s condition and response.

Give the medication as ordered; the order is correct

While the dose itself is appropriate, the timing is incorrect. Administering levothyroxine in the evening may reduce its effectiveness.

Change the dose to 200 mg, because that is the correct dose 

This is a dangerous and incorrect action. Levothyroxine doses are measured in micrograms (mcg), not milligrams (mg). 200 mg would be an extreme overdose and could cause life-threatening hyperthyroidism symptoms, including tachycardia, palpitations, and arrhythmias.

Summary:

The correct answer is Question the order, because the time of day is incorrect since levothyroxine should be taken in the morning on an empty stomach to maximize absorption. The other options are incorrect because the dose is appropriate, administering it as ordered would not be best practice, and changing the dose to 200 mg is a serious and dangerous error.

Correct Answer: Fatigue and muscle weakness

Explanation 

Fatigue and muscle weakness are key symptoms of hypokalemia (low potassium levels), which is a common and potentially dangerous side effect of hydrochlorothiazide (HCTZ). HCTZ is a thiazide diuretic used to treat hypertension by helping the body eliminate excess fluid. However, along with fluid loss, it can cause the loss of important electrolytes, especially potassium. Low potassium levels can lead to muscle weakness, cramps, fatigue, and even cardiac arrhythmias if left untreated. Therefore, it is most important for the nurse to instruct the client to report fatigue and muscle weakness immediately, as these may indicate serious electrolyte imbalances that require prompt intervention.

Why the other options are incorrect:

 Anxiety and heart palpitations

While these symptoms can be concerning, they are less directly associated with HCTZ. Heart palpitations might occur with electrolyte disturbances, but fatigue and muscle weakness are more classic and common signs of hypokalemia related to HCTZ use. Anxiety is not a typical side effect of HCTZ.

Abdominal cramping and diarrhea

These symptoms are not primary concerns with HCTZ. Although gastrointestinal upset can happen with any medication, they are not typical or dangerous side effects directly linked to HCTZ use. Diarrhea, in fact, could worsen dehydration and electrolyte loss, but it is not as common or as critical a symptom to watch for with HCTZ as signs of hypokalemia.

Confusion and personality changes

These symptoms are more likely related to severe sodium imbalances, neurological conditions, or other serious systemic problems, but they are not typical or early indicators of complications from HCTZ use. They would be less common and less expected than fatigue and muscle weakness, especially in the context of thiazide diuretics.

Summary:

When teaching a client who is taking hydrochlorothiazide (HCTZ), the most important symptoms to report are fatigue and muscle weakness, as these may indicate hypokalemia, a common and potentially life-threatening side effect.

While other symptoms like anxiety, heart palpitations, or confusion may be concerning in different contexts, they are not as directly related to HCTZ use as signs of electrolyte depletion, particularly potassium loss.

Correct Answer: Increasing growth.

Increasing growth

 Somatropin (Humatrope) is a recombinant human growth hormone (GH) used to treat growth hormone deficiency in children. The primary therapeutic effect of this medication is to stimulate linear growth by promoting the proliferation of growth plates in bones. It also helps with overall body development and metabolism regulation, making increased growth the expected outcome.

Explanation of Incorrect Answers:

Slowing down growth 

Somatropin is used specifically to promote growth, not slow it down. If growth is slowing, this may indicate an issue with dosage, administration, or an underlying medical condition that needs to be assessed.

Slowing down of weight gain 

Growth hormone therapy typically leads to an increase in lean body mass while reducing fat accumulation. It does not directly slow weight gain but instead promotes a healthier body composition.

 Increasing muscle strength 

While somatropin can contribute to improved muscle mass and function, this is not its primary indication. The primary goal of treatment is to increase height and overall growth rather than enhance muscle strength alone.

Summary:

Somatropin (Humatrope) is prescribed to stimulate growth in children with growth hormone deficiency. The correct answer is Increasing growth, as this medication helps promote linear height gain. It does not slow growth, reduce weight gain, or primarily focus on muscle strength. Nurses should monitor growth patterns regularly to ensure the medication is effective.

Correct Answer: Pentobarbital sodium (Nembutal Sodium) for sleep.

Explanation:

Pentobarbital sodium (Nembutal Sodium) for sleep: Contraindicated.

Pentobarbital is a barbiturate used as a sedative and can depress the respiratory system and decrease cardiac output. In a client with myxedema, whose metabolism is already slowed, this can worsen symptoms and potentially lead to respiratory depression or coma. Therefore, it is contraindicated in this population.

Why Other Options are Incorrect​​​​​​

Liothyronine (Cytomel) to replace iodine:

Not contraindicated. Liothyronine is a synthetic thyroid hormone replacement and is commonly prescribed for hypothyroidism or myxedema. It helps to replace deficient thyroid hormones and is beneficial in managing this condition.

Furosemide (Lasix) for relief of fluid retention:

Not contraindicated. Furosemide is a diuretic that can be used to treat fluid retention, a common issue in clients with myxedema. It should be used cautiously to avoid electrolyte imbalances but is generally safe for this purpose.

Nitroglycerin (Nitrostat) for angina pain:

Not contraindicated. Nitroglycerin is used to relieve angina pain by dilating blood vessels. It is generally safe in clients with myxedema, though caution may be needed in severe hypothyroidism as the body may not respond to vasodilation as effectively.

Conclusion:

Pentobarbital sodium (Nembutal Sodium) for sleep is contraindicated due to its depressive effects on the central nervous system, which could worsen the already impaired respiratory and cardiac function in a client with myxedema.

Correct Answer: Propranolol (Inderal)

Rationale:

Propranolol is a non-selective beta-blocker that blocks both beta-1 (heart) and beta-2 (lungs, liver) adrenergic receptors. In diabetic patients, propranolol can mask symptoms of hypoglycemia (such as tachycardia, palpitations, and tremors), making it difficult for the patient to recognize dangerously low blood sugar levels. Additionally, beta-blockers can impair glucose metabolism, leading to hyperglycemia or worsening insulin resistance, which is especially concerning for diabetic patients with heart failure.

Why the Other Options Are Incorrect

Losartan (Cozaar) 

Losartan is an angiotensin II receptor blocker (ARB) that is commonly used in both heart failure and diabetes. ARBs protect kidney function in diabetic patients by reducing proteinuria and delaying the progression of diabetic nephropathy. Therefore, it is a safe choice for a diabetic patient with heart failure.

Spironolactone (Aldactone) 

Spironolactone is a potassium-sparing diuretic that is used in heart failure to reduce fluid overload. While it can cause hyperkalemia, which should be monitored in diabetic patients (who may already be at risk for kidney dysfunction), it is not directly contraindicated in diabetes.

Dobutamine (Dobutrex) 

Dobutamine is a beta-1 agonist used to improve cardiac output in acute heart failure. It does not directly impact glucose metabolism or diabetes management, making it less concerning than propranolol for a diabetic patient.

Summary

The correct answer is Propranolol (Inderal) because it masks hypoglycemia symptoms and can worsen glucose control in diabetic patients. The other medications, Losartan (protects kidney function), Spironolactone (used for fluid retention), and Dobutamine (improves heart function acutely), do not have the same level of concern for diabetic patients.

Correct Answer: Liver function laboratory results.

Explanation

Duloxetine (a serotonin-norepinephrine reuptake inhibitor, or SNRI) is metabolized in the liver. Therefore, obtaining liver function laboratory results is critical before starting duloxetine. This medication can have hepatic side effects, and if a client has impaired liver function, there is an increased risk of toxicity or adverse effects. It is essential to assess the liver function to ensure the drug can be metabolized safely, and any necessary dose adjustments can be made.

Why the other options are less important:

Recent use of other antidepressants:

While it is important to know if the client has recently used other antidepressants, particularly to assess the risk of serotonin syndrome (if combining serotonergic drugs), this is not as critical as knowing the client's liver function. Duloxetine can interact with other antidepressants, but it is more immediately important to assess liver function before starting treatment.

 Family history of mental illness:

A family history of mental illness can provide insight into the client's predisposition to mood disorders or the likelihood of treatment response. However, it does not have an immediate impact on the safety or efficacy of duloxetine. While family history is important for overall treatment planning, it is not as urgent as assessing liver function.

Weight change in the last month:

Duloxetine can have some impact on appetite and weight, but weight change is not as critical to assess before starting the medication as liver function. If weight changes occur, they can be monitored over time, but liver function needs to be evaluated first due to the metabolic pathways involved with the drug.

Summary:

Before starting duloxetine, the nurse should prioritize obtaining the liver function laboratory results because of the potential hepatic side effects and the importance of ensuring safe metabolism of the drug. While other factors, such as the client's antidepressant history, family history, and weight change, are relevant, they are not as immediately critical as liver function when initiating duloxetine.

Correct Answer: Severe acute anaphylactic response.

Explanation

Severe acute anaphylactic response is correct because the symptoms described in the question are classic signs of anaphylaxis, which is a severe, life-threatening allergic reaction. Anaphylaxis typically occurs rapidly after exposure to an allergen such as penicillin and presents with symptoms such as:

Difficulty breathing due to airway swelling or bronchospasm.

Hives or urticaria, which are itchy, raised, red welts on the skin.

Hypotension or dangerously low blood pressure, caused by widespread vasodilation and increased capillary permeability.

Feeling ill, which may include dizziness, confusion, or a sense of impending doom.

Anaphylaxis is a medical emergency that requires immediate action, including administration of epinephrine, airway management, and supportive care. If not treated promptly, anaphylaxis can rapidly lead to respiratory failure, shock, and death. Penicillin is a well-known trigger of anaphylaxis in sensitive individuals, making this scenario highly indicative of this reaction.

Why the Other Options Are Wrong:

Side reaction that should resolve

A side reaction, also called a side effect, is an expected or predictable effect of a drug that is usually mild and not life-threatening. Examples of common penicillin side effects include mild nausea, diarrhea, or rash. However, difficulty breathing, hives, and hypotension are not typical side effects of penicillin. These are signs of a severe allergic reaction, not something that will simply resolve without intervention. Ignoring these symptoms under the assumption they will resolve could be fatal.

Idiosyncratic reaction is incorrect.

An idiosyncratic reaction is an unpredictable and uncommon reaction to a drug that is not related to the drug's normal effects and not due to an allergic mechanism. These reactions often occur due to genetic differences in drug metabolism. For example, some people may have unusual reactions to certain drugs, such as developing hemolytic anemia after taking specific medications. The symptoms in the question are typical of an allergic reaction, not an unusual or unique response unrelated to the immune system.

 Cumulative drug response is incorrect.

A cumulative drug response occurs when a drug builds up in the body over time due to repeated doses, typically when the body cannot adequately metabolize or excrete the drug. This can lead to toxicity. However, the client in the question took only the first dose of penicillin, so a cumulative response is impossible in this case. Additionally, cumulative toxicity usually presents with symptoms related to overdose, not with acute allergic signs like hives, difficulty breathing, or hypotension.

Summary:

The correct answer is Severe acute anaphylactic response because the client's symptoms are classic for anaphylaxis, which is a severe and life-threatening allergic reaction to penicillin requiring immediate emergency intervention. The other options are incorrect because side reactions are typically mild and not life-threatening, idiosyncratic reactions are rare and unpredictable without allergic features, and cumulative drug responses occur over time after repeated doses, which does not apply to a first dose reaction. Recognizing anaphylaxis quickly is critical to saving a person's life.